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HomeMy WebLinkAbout123 Ivy Lane DEPARTMEr ISION APPLICATION FOR HVAC PERMIT PERMIT# ,d ' TOWN OF SOUTH WINDSOR Application ' eby: BUILDING DEPARTMENT Ow PRQ 1540 SULLIVAN AVENUE ,y Bldg.Permit# 3 .,.. � 644-2511 ext. 230 �q Da a soi*g Inspector Application must be printed or typed FEE SCHTE Loca 'on of Job: $0-$1,000, f'$:00 Street No. Street Lot No. Over$1, $15.00 per, 0 or any fractict eof Tenant Designation Apt.No. J r, "# `= APPLICANT Oil APPLICANT ADDRESS V 91, rA a 7 APPLICANT PHONE# O� N u. OWNER I u� OWNER ADDRESS 0 -3 —T:VAka , .M OWNER PHONE (� ^ C7 W v� 3 I Z 7 ESTIMATED COST$ o2 9 D IS THIS A CONTRACT COST? kYes No r' Ja FEE ENCLOSED$ TYPE OF JOB: New Installation Alteration/Additi n/Repair Revised 4/01//2W2 APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF YSTEM: TYPE OF BUILDING: iEATING ❑RESIDENTIAL ❑A/C ❑COMMERCIAL ❑VENTILATION ❑INDUSTRIAL HEATING ❑STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑HYDRONIC XWARM 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.) e-e-wt- K ac+k t S GROSS HEATING CAPACITY(INPUT BTUH) �0 NET RATING(OUTPUT—BTUH) V ©b O TYPE OF FUEL ❑ OIL--GPM OIL TANK LOCATION:❑INSIDE❑OUTSIDE CAPACITY AGAS—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. CONTRACTORS LICENSE TYPE STATE SIGNATURE OF APPLICAN , DATE �" 3