HomeMy WebLinkAbout125 Ellington Road (15) T.W.C. Job #4516-H
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WIlVDSOR PERMIT#
Application is hereby: � ( (0 L(3
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
' 2K GZ � 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
125 Ellington Road
$0-$1,000=$15.00 Street No. Street Lot No. _
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Charles Baldis c/o The Wetherell Corporation
APPLICANT ADDRESS 49 Shield St./P.O. Box 330376
West Hartford, Cr 06133-0376
APPLICANT PHONE# (860) 953-4012
W N 3 OWNER DST — Output
'� q� OWNER ADDRESS 125 Ellington Road
4
�.
South Windsor, CT
OWNER PHONE (860) 290-7000
ESTIMATED COST$ 6,318.00
� IS THIS A CONTRACT COST? X Yes No
` FEE ENCLOSED$ 105.00
�1
TYPE OF JOB:
OR-C X New Installation
Alteration/Addition/Rep air
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
®HEATING ❑RESIDENTIAL
❑A/C W 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) OF(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)
Installing two (2) silencers for emergency generators and
FURTHER DESCRIPTION OF WORK tank vent/emergency vent piping to outside.
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.
300183 S1 CT
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT , wee- DATE
Charles Baldis