HomeMy WebLinkAbout16 Kupchunos Drive DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Applicati�� y:
TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
:?_� 644-2511 ext. 230 �y
Date B Id' Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
6 �� �U oJ,
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS _ ��
APPLICANT PHO #
O W N St OWNER
At 4 OWNER ADDRESS Z6
r'� � � .�•,# �, OWNER PHONE Le
C ESTIMATED COST$ 3
* '� IS THIS A CONTRACT COST? (- Yes No
l� " FEE ENCLOSED$ V r If ov
�� TYPE OF JOB:
�soR, o�
New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OFF SYSTEM: TYPE OF BUILDING:
014EATING &RESIDENTIAL
❑A/C ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ ST AM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
U-ffYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION T
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
D ClTE ALL HE ATING`�PMEl�JT�(INCLUDING M 7DEL;iO.) /ya 67"I ��
GROSS HEATING CAPACITY(INPUT-BTUH)I�D NET RATING(OUTPUT-BTUH) A
TYPE OF FUEL /
3-61-L-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) �
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.
r 303//,3 S --/ Ct
CONTRACTORS LICENSE NO. TYPE r STATE
SIGNATURE OF APPLICANT .� �/���� G�� DATE 1 ",