HomeMy WebLinkAbout125 Ellington Road (8) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WIlVDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 o2 S c 73
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Efate' Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
z a? 461111"ClIvr? koad
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
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APPLICANT 13- C l e J-7 a rl/ECG l2 0n 7�24 C-
APPLICANT ADDRESS S eC o n / /► ✓e.h c4
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MA a/o20
APPLICANT PHONE# 3-� 2 - s-3 D O
oW N S OWNER iZCT �f
�4< OWNER ADDRESS
O * µ OWNER PHONE
C ESTIMATED COST$ 9S� OU0
IS THIS A CONTRACT COST? Yes No !
FEE ENCLOSED$ Us i
TYPE OF JOB:
`FOR C ✓New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
8 HEATING ❑RESIDENTIAL
Ek A/C ❑COMMERCIAL
0 VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC Ga'WARM 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)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
40-lor f U,r U12/
Did IVO /Z1 OWC-/
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH)
TYPE OF FUEL
❑ OIL—GPM OIL TANK LOCATION:❑INSIDE❑ OUTSIDE CAPACITY
CAS—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) /2 0006)p
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 All fi ew -"OCR-r kg U/7 r /3 At- n f tO e,��� 7�/ Owl
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.
S/ 3 S ?5' 93 s 1 4ek� rx I t�pl I CT
CONTRACTORS LICENSE N Ej STATE
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SIGNATURE OF APPLICANT ✓ DATE
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