HomeMy WebLinkAbout12 Kelly Road (8) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WIl�TDSOR rPERMIT#
Application is hereby: /1 7 ,3oZ
BUILDING DEPARTMENT
PROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONi#
OWN
S OWNER S
q< OWNER ADDRESS S
C*1 - * # OWNER PHONE Z Z- 3 I
C ESTIMATED COST$ �g O a
Vol
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
OIt•C 0� New 1 Instal ation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
❑HEATING ❑RESIDENTIAL
wwC ❑COMMERCIAL
_ EN'')_L OI_ U INDU�`�'RIAL,
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 r OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT-BTUIT) 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 N INSIDE OF DIFFERENCE °F
TOTAL HEAT GAIN(BTUH)/L (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
0 /Z
TONNAGE COOLING CAPACITY(BTUH) VZ-0 d
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.
f
CONTRAC OR LICENSE TYPE STATE
SIGNATURE OF APPLICAN DATE
R E C E I V I N G C a
SIN 6025 RIGHT-J SHORT FORM
File name:
Job t: Ht9 C19
For: Outside db 4 Be
Inside db 70 15
Design TD 66 13
Daily Range - M
Inside Humid. - 50
By: HERITAGE OIL Grains Water - 29
Method Simplified
Const. glty Average
Fireplaces I
HEATING EQUIPMENT COOLING EQUIPMENT
Make Make
Model Model
Type Type
Efficiency / HSPF 0.0 COP/EER/SEER 0.0
Heating Input 0 Btuh Sensible Cooling 0 Btuh
Heating Output 0 Btuh latent Cooling 0 Btuh
Heating Temp Rise 0 Deg F Total Cooling 0 Btuh
Actual Heating Fan 1400 CFN Actual Cooling Fan 1400 CFM
Htg Air Flow Factor 0.019 CFM/Btuh Clg Air Flow Factor 0.042 CFM/Btuh
Space Thermostat load Sensible Heat Ratio 85
ROOM NAME I AREA I HTG I CLG I HTG I CLG
SQ.FT. { BTUH I BTUH { CFN CFM
DEN I 160 I 5908 I 2146 i 110 1 89
FAMILY ROOM { 272 ( 9821 { 4591 ( 183 { 191
BREAKFAST I 96 i 8376 I 4179 I 156 I 174
KITCHEN I 120 I 1907 I 2632 I 35 { 110
DINING ROOM ( 210 I 6646 I 1707 ( 124 71
FOYER I 192 I 9735 I 1852 i 181 I 11
LIVING ROOM ( 224 { 6860 { 2348 { 128 { 98
MASTER BATH I 192 I 5967 I 4193 I 111 I 175
BEDROOM 3 ( 192 ( 3814 { 1606 { 71 { 61
BEDROOM 4 I 100 I 3973 I 1518 I 14 { 66
tAUNDRY/ BATH ( 100 ( 736 ( 2760 { 14 { 115
BEDROOM 2 I 140 I 4267 I 1201 I 19 I 5o
MASTER BEDROOM 260 { 7182 { 2708 { 134 ( 116
Entire House d{ 2258 { 75198 { 33581 { 1400 { 1400
Ventilation Air I 1 0 1 0 1 1
Equip. 0 0.95 RSM ( ( ( 31902 I {
Latent Cooling I I i 5939 I
TOTALS ( 2258 I 75198 ( 37841 I 1400 I 1400
MANUAL J: 1th Ed. RIGHT-J: V2.11