HomeMy WebLinkAbout120 Newberry Road (2) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
Z644-2511 ext. 230
1014�j
Building Inspector
Application must be printed or typed
FEE SCHEDULE Location o ob:
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Q G�•✓,1' O / �-
APPLICANT ADDRESS
APPLICANT PHONE# 0'— 6
W N S OWNER �� , ` c�d/
OWNER M3 RESS / 2-0 /V e c,,u
} d ail �a/rcn
OWNER PHONE 0
ESTIMATED COST$ ,j 5 0. 0 Q
IS THIS A CONTRACT COST? ❑ Yes .0*46
FEE ENCLOSED$
, S•OR-Co� TYPE OF JOB:
�w Installation
0 Alteration/Addition/Repair Revised 5101
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
jitHEATING SVIDENTIAL
❑A/C ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
RONIC ❑WARM 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)
DESCWE ALL HEATING EQUIPMENT INCLUDING MAKE MODEL NO.)
GROSS HEATING CAPACITY(INPUT—BTUH)/1 42W NET RATING(OUTPUT BTUH) le
_a
TYPE OF FUEL
,,�
ICJ OIL--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
Al
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.
17
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE