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HomeMy WebLinkAbout1021 Main Street DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# -21�(/63 <JX-'Z— 644-2511 ext. 230 ate Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: $0-$131000=$13.00 Street No. Street Lot No. Over$1,000= �h � _ 1LL 0 per$1,000 (� e/-7-w, or any fraction thereof Tenant Designation - /l Apt.No. APPLICANT -tTAL,,)_ ll�-- APPLICANT ADDRESS P,�/tp e lZ APPLICANT PHONE# to J7 -3 -3O g W p S OWNER 3FI I t 1 /V Al 0 fZ TV OWNER ADDRESS 75100 ✓ems S, /W ` OWNER PHONE C MID ESTMIATED COST$ W 8 e�,00 IS THIS A CONTRACT COST? des 0 No CJ FEE ENCLOSED$ �� TYPE OF JOB: OR-COa New Installation 13-Alteration/A ddition/Rep air Revised 8/99 APPLICATION FOR HVAC PERMIT (Continued from reverse side TYPE OFF SYSTEM: TYPE OF B DING: ❑hREATING U4ES DENTIAL ❑A/C ❑COMMERCIAL ❑VENTILATION ❑INDUSTRIAL HEATING ll 6 TEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑HYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER EXISTING RADIATION-586 ZVADDITIONAL RADIATION TOTAL RADIATION 3 S DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT LOSS(BTUH) °F(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.) 5f;r) / 7--�j 4 5r---c - S�-�-Vl ►- GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) TYPE OF FUEL Ua"iL—GPM r u 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. -;" ©3 CO TORS LICENSE NO. ;7E STATE SIGNATURE OF APPLICANT y f, �' ' ��e— DATE �s