HomeMy WebLinkAbout160 Quarry Brook Drive 1
DEPARTMENT DECISION APPLICATION FOR 1 " .# ; T
PERMPI'#
Application is hereby: TOWN OF SOUTH .�
BUILDING DES'
APPROVED 1540 SULLIVAN A Bldg.Permit#
G3 � � 644-2511 ext.2"
]Jatd Building Inspectors
Application mmst be ,or
k r.^
FEE SCHEDULE
1 CG B
$0-$1,000=$15.00 Street No. ;� Lot No.
Over$1,000= f °
$15.00 per$1,000or any fraction thereof Tenant Designation Apt.No.
APPLICANT e =44*2
APPLICANT ADDRESS
-Z)za
APPLICANT PHONE#
W N S F OWNER
O q
OWNER ADDRESS .0
ct. .s. l�..
OWNER PHONE -� __ .� ,._
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ -�
TYPE OF JOB:
SOR-C0 X-New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
❑HEATING @ RESIDENTIAL
)WAIC ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
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 OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT—BTUH) 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 q5 OF INSIDE-7S OF DIFFERENCL�—' OF
TOTAL HEAT GAIN(BTUH) i a (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIA ALL COOLING E UIP NT(INCLUDING MAKE& ODEL NO.)
,pfJ l 2 �C
TONNAGE COOLING CAPACITY(BTUH) ��a
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.
363 l0;)L,
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT � DATE 13A,10
r ) .
-� COOLING HEAT GAIN CALCULATION
lice
.., _
t. NAME OF ROOM 114 The2j06 3 4W 4 Z. 5. f� 1. 8. 9, iQ 11.
Z ROOM WIDTH& LENGTH ,r X�[ �/ [
3. RUNNING FT,EXPOSEO WALL I
4. CEILING HEIGHT --Z
FACTOR I
1.WINDOW • •TIMES. . $' �? �ta
�dFACTOR I `t� ZD11
EMS. SO.FT. �..�
Z.WALLS • TIMES ... e��
•.-r• _ :FACTOR �� 3� 3a _
Jr
'COLD SCL
PARTITIONS TIMES
FACTOR
4."CDUl1H -• .TIMES 7: -,•.Y 3 l �?!0 1�G 1-5
'�•�v.. rev„ •I..FACTOR•K�•.iM /,� 7 / � i
64
(uN :.���
iCFLOOR,^. : =7nlMEs••�rt..�..
�.r'=•�`t�z-•;art:FACTOR• I
&•TOTAL MN :. sue•� 1
jq8�Z'16-233
2`f�j 34R, 3,4 OJV I///Y
T. RSoulRm BRAN
CH SIZE ;►.x.:: . i I I I I .
tip'
TOTAL HEAT GAIN 4) 3 /Zl UNIT MODEL NO 1X1�A17f
• N.
MLJNICPALXrY D!/
JOB ADDRESS CL STARTING DATE- z 3 tz
JOB DESCRIPTION a
PER PUCK ACT 91-95
THIS LETTER AUTHORIZES
TO SIGN TIE PERMIT AS AN AGENT OF D. SKA FOR THE ABOVE JOB.
D.LISKA
HEATING,PIPING&CP—Q UTNLIMTTED CONTRACTOR'
C1 L 13 L�Si gi�'' ,: 4` O''NTRACTOR
I.nrnTEn .,�rL.c
2 4f''PLE�'3�D MTC In 0--T 1Sil
S GL UR 06073 �2 P�.E it D,,
"IrYlt#='$1 - SG 'I'i3 Y,.C-T 06073
LIC./REG NQ, _ $,f IVE , ' ' EXPIRES LIC./REG NO,_ y^ Yg IVEr-. 'j y. _ EXPIRES
303102 ;ow 091 IM025K�i': --V/31/2003 <<oL, j
:rRANS7'�,< `' 2531 r'` AQr ry �" 13112103
SIGNED /�� SIGNED