HomeMy WebLinkAbout2163 Ellington Road (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext.230
Date Building Inspector
Application must be printed or typed
Location ofjob
n o
Street No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt. No.
Over $1,000
12.00 per$1,000 OWNER c o n! Go `!t Au S
or any fraction thereof
ADDRESS dZ 14 3 l l2
SO Wt Zc SddZ Gl d (oO7Y
owNERs PHoNE# $60 - 113.Z— ? 6 ! 7
APPLICANT G r 6.6GT-1?l C-
At O W N S F ADDRESS
i
1;
ESTIMATED COST$
o
C f` IS T15S A CONTRACT COST?
YES NO
6V
1 FEE ENCLOSED $
SOR-CO TWE OF JOB:
ginal Installation
Alteration/Addition/Repair
Revised 11/95
i
APPLICATION FOR ELECTRICAL PERMIT(Continued from rcvcrse side)
TYPE 9F BUILDING
IS THIS APPLICATION ASSOCIATED WITH
RESIDENTIAL BUILDING PERMIT APPLICATION YES 16NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY e-s 41e,4
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Other plcasc specify)
TYPE OF INSTALLATION/WIRING METHOD AJ?4,/
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED 7 YES/NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHESd NUMBER OF OUTLETS
NUMBER OF LIGHT FI S
NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS /
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILD G CODES IN THE
PERFORMANCE OF SUCH WORK.
1-7-- - /u,a I
ec7,,l -,-zr-w
NAME STATE LICENSE NO. TYPE SIGNArprJRE OF APPLICANT
PHONE NO. S T DATE ,r— -7-D 3
Shirley Wilhelm -CRS;Ap royal Confirmation: Request No. 263228 Pale'I
From: dpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 5/28/03 7:59AM
Subject: CRS Approval Confirmation: Request No. 263228
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:263228
House No:2163
Lot No:
Street Name: ELLINGTON RD
Town Name:SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: May 28, 2003