Village of Elk Grove Village Permit No.

901 Wellington Ave, Elk Grove Village, IL 60007

Phone: 847-357-4220 Fax: 847-357-4222

APPLICATION FOR PERMIT TO DO ELECTRICAL WORK

The Permit issued on this application will authorize only work specified. Contractor must give complete information indicated.

212 Croseen Ave.

Job Address _______________________________________________________________
LIGHTING CIRCUITS AND OUTLETS

Chicago Aquaponics LLC 2 Wire 3 Wire 4 Wire

Owner ______________________________________________________________
15 AMP, CIRCUIT
312-799-1819
Owner Phone _______________________________________________________
20 AMP, CIRCUIT
kdantoniou@gmail.com
Owner Email _______________________________________________________ 30 AMP, CIRCUIT

Parcel/ PIN # _ ___________________________________________________________________________________________________________________________ ________________________________________

OUTLETS ON EXISTING CIRCUITS
TOTAL
A-Tower Electric & Construction
Electrical Contractor _______________________________________________________ LAMPS, FIXTURES,
SOCKETS, RECEPTACLE
632 Bohland Ave.
Address ___________________________________________________________________ 50 watt or less 60 watt 75 watt 100 watt 150 watt

Bellwood
City __________________________________________ State _______ Zip _____________
IL 60104
200 watt 300 watt 500 watt Switches 100 watt
708-774-5492
Phone _________________________
A-tec@live.com
Email _____________________________________

William Diaz
Print Name of Electrician __________________________________________________ FLOURECENT LAMPS

20 watt 40 watt 100 watt

______________________________________________________________________
Signature of Qualified Electrician

Registered At
Naperville
__________________________________________________________________________________ Reg. No
22-00008264
_________________________________________________________
POWER
Number Total H.P.
Valuation of Work $ ____________________________________________________________ AIR CONDITIONERS

APPLIANCES
Work to be done, Service Revisions, Other Apparatus, Repairs, Etc. __________
MOTORS
____________________________________________________________________
TOTAL
____________________________________________________________________

____________________________________________________________________ MISCELLANEOUS
Number NO. CIRCUITS PER KVA
____________________________________________________________________
PANEL BOARDS
____________________________________________________________________ TRANSFORMERS
OTHER
FEE: ____________________ TOTAL

SINGLE FAMILY DWELLING

Village Use Only Number of Sq. Ft. Number of Openings

Reviewed & Recommended: Issued By:

_____________________________ ______________________________
Name Date Director, Community Development