HomeMy WebLinkAbout2719 Ellington Road (5)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: 3BUILDINGDEPARTMENT
App VED 1540 SULLIVAN AVENUE Bldg.Permit#
LA
644-2511 ext. 230
i
ate Building Inspector
Application must be printed or typed
Location of J9)9FEESCHEDULE
4 1 '7d
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
I
APPLICANT
APPLICANT ADDRE/SSS
Il ivrr Iw % a dead
APPLICANT PHONE#
N N S OWNER /!a r
q OWNER ADDRE h
OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes VINo,
FEE ENCLOSED$5,
f1 r TYPE OF JOB:
S R•C ew Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATE WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? MYES NO
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 OP
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRI TION OF WORK
01
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.
2/
CONTRACTORS LICENSE NO. T STATE
SIGNATURE OF APPLIC
r
DATE
Shirley Wilhelm.-..CRS Approval Confirmation: Request No. 210991 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 7/5/02 12:46PM
Subject: CRS Approval Confirmation: Request No. 210991
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 210991
House No: 2791
Lot No:
Street Name: ELLINGTON RD
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Jul 05, 2002