HomeMy WebLinkAbout157 Burgess Road (2) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Application is PERMIT#
b : TOWN OF SOUTH WINDSOR E R.0 T
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
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644-2511 ext. 230 4�k
Date Bu' g Inspector
Application must be printed or typed
Location of b•
FEE SCHEDULE 7 11?6e,0ecz
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$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS I?
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APPLICANT PHONE' #
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OWNER PHONE
C ESTIMATED COST$
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IS THIS A CONTRACT COST? 41rYes 13 No
FEE ENCLOSED$
SO O�� TYPE OF JOB:
R•C
13 New Installation
ration/Addition/Repair Revised 8/99
4
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF BUILDING:
EATING ❑RESIDENTIAL
❑A/C QOCOMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRES
SURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC 1ARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCIVBE A4 HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
t e,
GROSS HEATING CAPACITY INPUT—BTUH)/*a-066 NET RATING(OUTPUT—BTUH)
TYPE OF F
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)
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 WORK.
5- l 3oz4D(a7/-)
CONTRACTORS LICEN N . / TYPE STATE
SIGNATURE OF APPLICAN DATE ` ��