HomeMy WebLinkAbout1 Arrowwood Circle d
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
3
1540 SULLIVAN AVENUE
Bldg.Permit#
Z G 644-2511 ext. 230
bad Building Inspector
Application must be printed or typed
FEE SCHEDULE Lo ati of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation ::X�p:t.No.
i
i
a
a
APPLICANT
r � '
ICANTODRESS
b
1'
APPLICANT PHO #
OWN SF OWNER
OWNER ADDRE S '
0 OWNER PHONE i
ESTIMATED COST$
IS THIS A CONTRACT COST? NZYes No
j� FEE ENCLOSED$ (O
TYPE OF JOB:
dSOR.Co
w Installation
Alteration/Addition/Repair
Revised 4/01//2002
A PLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF STEM: TYPE OF BUILDING:
HEATING ❑RESIDENTIAL
❑A/C ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
g4AM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
RONIC ❑WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE�, F DIFFERENCE °F
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DE CRs BALL H G EQUIPMENT(INCLUDING MAKE&MODEL NO.)
v
GROSS HEATING CAPACITY(INPUT-BTUH)7—�-00014ET RATING(OUTPUT-BTUH)
TYPE OF FUEL
34 IL-GPM OIL TANK LOCATION:❑INSIDE❑OUTSIDE CAPACITY
GAS-INPUT �Q .PG TANK CAPACITY ELECTRIC-KW
AIR CONDITIONING
DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
TONNAGE COOLING CAPACITY(BTUH)
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM)
(PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WORK "
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 W C4 ,
,4;�2a56-CONTRACTORS LICE SE NO. TYP i ATE
SIGNATURE OF APPLICAN DATE