HomeMy WebLinkAbout124 Brookfield Street (3) t
FEION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 4rtL---�
nspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
Area k Eela
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �AC,°
APPLICANT ADDRESS ^('.pnA 4e-
APPLICANT PHONE# (ev ,��
O\4 N 8,0 OWNER "t6 u (Ss a�l� Lorry C1x�
44 OWNER ADDRESS
0. t lJ sur Lfi.
OWNER PHONE
O
C ESTIMATED COST$ /0, 060
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
0R C New Installation
Alteration/Addition/Repair
r
Revised 4/01H2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side) -
TYPE OF SYSTEM: TYPE OF BUILDING:
❑HEATING ❑RESIDENTIAL
❑A/C ❑COMMERCIAL
AVENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) °F(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMEN (INCLUDING AKE&MODE NO.)
vrl" (�c S�T n S S S P A�� n e ,.� b 6 J 7� N
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT BTUH)
TYPE OF FUEL
❑ OIL—GPM OIL TANK LOCATION:❑INSIDE❑OUTSIDE CAPACITY
❑GAS—INPUT LPG 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)
U,- fir- YnA
TOTAL SIZE OF SYSTEM(CFM)a?rOy 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 WORK.
- �,M C' c f
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLIC T I DATE