HomeMy WebLinkAbout114 Cornerstone Drive DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT l
AP 1540 SULLIVAN AVENUE Bldg.Permit#
f
�n 644-2511 ext. 230 i
ate Building Inspector
Application must be printed or typed
F$0FEESCHEDULE
Location of Job:
1 `
-$1,000=$15.00 [Te-nant
reet No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Designation Apt.No.
1
APPLICANT CA C
APPLICANT ADDRESS '3�'�A P�,
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APPLICANT PHONE# ��
OWN S� OWNER 2'C
'4� OWNER ADDRESSa
OWNER PHONE
C ;D ESTIMATED COST$ s o U
IS THIS A CONTRACT COST? Yes No
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FEE ENCLOSED$ Y v
TYPE OF JOB:
SOR-CO New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF UILDING:
HEATING RESIDENTIAL
A/C COMMERCIAL
❑VENTILATION ❑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 EQUIPMENT(INCLUDING MAKE&MODEL NO.)
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)
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM)
(PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WORKlyv-,)�e C-�>(A
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.
cI `) :1 S-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE �
6