HomeMy WebLinkAbout2241 Ellington RoadDEPARTMENT
MRTMENT
DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
plication is hereby:TOWN OF SOUTH WIlVDSOR
BUILDING DEPARTENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230
Building Inspector
must be printed or typed
For EE SCHEDULE Location of Job:
e i ir.g)7 2/2 r(e!
1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE# ka2 j5:
OW N S 4. OWNER . S5Z22 I ,
OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$ ,pOCS , a
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
s R'CO ew Installation
Alteration/Addition/Repair
Revised 4/01//2002 j
I
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ElYES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? 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
IV e-w/ C I'1 e
d tj t 7LO C20a Ajn v e
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 cf3 C/
F 3 C
CONTRACTORS LICENSE NO. TYPE STATE
G `"DATE / CJSIGNATUREOFAPPLICANT
5K
Shirley Wilhelm -CRS Approval Confirmation: Request No. 238939 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date:1/15/03 3:34PM
Subject: CRS Approval Confirmation: Request No. 238939
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 238939
House No:2241
Lot No:
Street Name: ELLINGTON RD
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Jan 15, 2003