HomeMy WebLinkAbout2783 ELLINGTON RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application i y: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
D 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT SOL CANTOR ELECTRIC, INC.
APPLICANT ADDRESS 98 E. Main Street P.O. Box 836
ROCKVILLE, CONNECTICUT 06066
Phone 875-0765 ---
APPLICANT PHONE#
0W N St-4
t-4 OWNER ,
OWNER ADDRESS
�' ><�� �`X xY-•��'�r' CST C'�( a('�`-1�
k F, OWNER PHONE
O '-
t" ;D ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ Icj
TYPE OF JOB:
SpR.C���
_New Installation
Alteration/Addition/Repair
Revised 4/01H2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
❑RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES L� NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑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 I(j- SIZE OF MAIN CONDUCTORS
NUMBER OF METERS_� NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS I 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
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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 APPLICA DATE
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Electric# APPLICATION FOR BUILDING PERMIT
Plumbing# 2783 Ellington Road
HVAC # 9 Date: - Q `�- OS
Sprinkler# 32001
FINAL PR —_- _— __- -— - ------ Estimated Cost
j Permit Fee $ T
Buildin�� t v' COMPLETE RED BOXED AREAS Occupancy Fee $
Enginee'it TYPE OR PRINT ONLY Eng. Insp. Fee $
Affidavit
for C ► SIGN ON REVERSE SIDE / S
PP - - - ------ - - -- Total Fee $
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant Location of WorQ2 M Si q Lot No.
Applicant's Address 79S j Tel.# 4Ss q 29
Town ' Zip G? Lic.#
Owner :er Architect
Owner's Address Architect's Address
Zip Zip
Sq. Ft. New Area: 1st FI. 2nd A. 3rd FI. Total New Area
Purpose of this permit ✓2�� Z Gam/
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP Cert. Area Basement Garage
Approved by Date Use Group,,=::::=onstruction Typ
Revised 6102
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in which this builse is allowed.
Signed
I hereby apply for a Certificate of Occupancy for the work described in this application for the permit.
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS