HomeMy WebLinkAbout11 Haystack Lane DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR 11711
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
3 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE 14^1-527�
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$0- $1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C Gti✓ O �d
APPLICANT ADDRESS 12
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APPLICANT PHONE# ��� ✓ o ®�
N S OWNER a t.l % ✓��/�
O � ER ADDRESS
O .;�,•A � �, OWNER PHONE
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ESTEVATED COST$ D/ rr 019
IS THIS A CONTRACT COST? o Yes —No
FEE ENCLOSED$ //0 f 0 U
TYPE OF JOB:
OR-Co
New Installation
0 Alteration/Addition/Repair Revised 5101
APPLICATION FOR HVAC PERIMT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
,EATING ❑RESIDENTIAL
/AfC El COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC §LWARM 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 ALIT HEATING E UIPMF�NT(INCLUDING MAKE&MOD�LTO.)
`f� ✓/l�t G� /�/�c/e o..� / rrt j ��c yya C e 44 BW-e l o'L/6
GROSS HEATING CAPACITY(INPUT—BTUH) I_>b Z 50NET RATING(OUTPUT BTUH) 12S.Gad
TYPE OF FU
YL
0�6IL--GPM ,/0 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&4102EL NO.)
Arz y-If 0-1 '540,m
TONNAGE COOLING CAPACITY(BTUH) UCH
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
TOTAL SIZE OF SYSTEM(CFM)2 000 FRESH AIR INTAKE(CFM)
io
(PLANS MUST ACCOMPANY APPLICATION)
FURTHER
/DESCRIPTION OF WORK - l ,.tee L �^�'—.
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.
�d3�29z S / 4-""7-
CONTRACTORS LICENSE NO. TYPE E
SIGNATURE OF APPLICANT DATE
11l;74