HomeMy WebLinkAbout125 Ellington Road (3)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: I a 0BUILDINGDEPARTMENTD
1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
1 in
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT EA t:c,T M i r alx COAL-0,
APPLICANT ADDRESS _k 0
APPLICANT PHONE# 84 00* N S OWNER
OWNER ADDRESS f -
J
y
OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? >IrXes o No
FEE ENCLOSED$ 0. n43 - 0 O °K
oOR
TYPE OF JOB: t WC
El New Installation
ration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATE WITH A
El RESIDENTIAL
BUILDING PERMIT APPLICATION S ElNO
BUSINESS CURRENT U - '.ND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME IA C.PHONE 'T 13—3 q—Z.I Z,7
ACTORY
STORAGE ADDRESS No
GARAGE
MIXED USE CITY 0ve4p.v.,?b yo,.(- STATES ZIP 442- i3
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD r
SIZE OF SERVICE (r 300 b SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS 02—
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? (3 YES)-NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
J l ern. SP J • ( i C+i 7 i s h y
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF AMAGMTIT DATE CA-
Shirley Wilhelm -CRS Ap royal Confirmation: Re pest No. 228509 Pa e 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 9/30/02 12:24PM
Subj ct: CRS Approval Confirmation: Request No. 228509
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:228509
House No:125
Lot No:
Street Name: ELLINGTON RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Sep 30, 2002