HomeMy WebLinkAbout1104 Ellington RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Applicatio h TOWN OF SOUTH WIl TDSOR
S.BUILDING DEPARTMENT 17
APPROVE 1540 SULLIVAN AVENUE
Bldg.Permit#644-2511 ext. 230
Date Bui Inspector
Application must be printed or typed
FEE SCHEDULE Location f Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS S U Y3 V--&-)`-
C6 -
F C>(o
APPLICANT PHONE#2 (' a 5 O
OW N Se OWNER , i2.S Del-
q OWNER ADDRESS fct(
t
V. OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ /b is
TYPE OF JOB:dSOR,Cps New Installation
4-Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? 7-
YES NO
n
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 V
SIZE OF SERVICE lefn 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 l
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. HYPE STATE
SIGNATURE OF APPLICANT DATE a
Shirley Wilhelm -CRS Approval Confirmation: Request No. 224254 Page 1
s
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 8/21/02 12:12PM
Subj ct: CRS Approval Confirmation: Request No. 224254
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 224254
House No: 1104
Lot No:
Street Name: ELLINGTON RD
Town Name: SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Aug 21, 2002