HomeMy WebLinkAbout1739 Ellington Road (33) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT 116
APPR 1540 SULLIVAN AVENUE Bldg.Permit#
IN 5 644-2511 ext. 230
Date Building Inspector
Application
pp cation 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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 67e/,t
APPLICANT ADDRESS —7
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APPLICANT PHONE# -
W N S OWNER I
O F-4 OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$
��► IS THIS A CONTRACT COST? yYes No
FEE ENCLOSED$ �vQ CA JI a��V 1'T - 3
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TYPE OF JOB:
OR.C 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
�fA/C ❑COMMERCIAL
I�LVIENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC ;d WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE C OF INSIDE 7✓ OF DIFFERENCE 7✓ 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
O 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.
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CONTRACTORS LICENSE NO. TYPE STATE
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SIGNATURE OF APPLICANT DATE�� ,