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HomeMy WebLinkAbout119 Scott Drive Application No. 6472 Permit No. 6202 TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. hereby make application for a permit to (erect (rnZd --- ' --o) a building according to the following detailed statement of the specifications and plans herewith submitted. (Draw a line thr ugh word "erect" or words "make alteration to" as the case may require.) All provisions of the Building By-Laws (Sections 2 to 32 inclusive) shall be complied with in the execu- tion of this work whether specified herein or not. _ South Windsor, Conn. 10 Signh ..... ... ... ........... .......... Address j:rorj4.V77.e. .. Y ,...0.09WC-4 Vto 7r� Location? . ... ... ..................... .......... sc?c, z'hf.......side of? .? .t? 7'.... ..................... Nearest cross streets <...r' ..... .. . .............Street No. . �..,,�................. No. ...14�..... . f � �—� Owner of land is. ... .... ....00 vA... 0�' ....Address ..1. ! 1 S.T......... Owner of building is? ...................... ... ........... .. .............Address . .. . Y...... ........................................................................................ . ..... M / Architect is ...'^ .Address I .. .................... Builderis? ......................................V.................................................................Address .............&.................................................................................... ...........ju a Dimensions of building? ��'•� l0 Feet rear? ..�� ...... Feet deep? ...g.�p �......Feet front. ..... e Extreme height to highest point of roof? ..... ..../... F...... No. of stories in heights s eo o se of building is�. e.. .�.L,.c..,nt/.+�....................No. of stores? ..... ............... .................. ............................... .............. owmany families? .... ......... .....a- t......._...................................No. of rooms? .... ...........'�'......................... ............................................ Distance from street line is? ... .. f'... ............. .....from building line is? ....... ... 7 t............................... ADDITIONS AND ALTERATIONS (Give Brief Description) ............................................. .............._..... ......................................;. r .....�::........� ... `.... ................ �!!..": ......... ................ . ................................................................................................................ .......... .. .......... ..................................................... ....................................... 1� t '0:�,'�)ANCF W!TX TOWN OF Map No. U1" VII! If of steel frame, what is exterior construction? . ... ... ....... What kind of columns used? ............... ...................... .. .....Size of columns used? What length of columns used? . ...How protected? What kind of beams or girders? ..... ... Size of beams or girders? ... . ... ..... .. .... .... .. Longest span of beams or girders? . ..... ......... .. ... . These rest on? Roof construction is? ....................... .....................................................Roof covering is? The floors are of ........ construction and are calculated to carry a safe load of lbs. per square foot. (See Section 14, Building By-Laws.) BRICK CONSTRUCTION. Of what material will walls be constructed? ............ ....... ... ..... .. .... .. Composition of mortar? .. .............. Height and Thickness of Walls Helg4t Stories Front Walls Side Walls Rear Walls Partition Walls Basement, ........................................__............................................................. .........._........................._....................................................................................................................................... . 1st Story ............................ ................_....................._.......................................................................................................................................................... ...................... .............................. .. .... 2nd " ........................................_......._........._....................................................................._......-.......................... ............ .......... .......................... .............. ...................... ...... 3rd " ......................._......................-.... .................................................r............................................. ........................................... ................................................. .......................... ..... .. .... 4t'h is ......................... ............._........................................................,................................................................................................................................................. ............ .......... ............ ..... 5th " .................................. ................ .................................. .............. ........... .... ..................................-................................................................................. .................................................. 6th " ............. .......... .........._.................._.................. ................................................ ........................-.................................. ............... ............................................................................. Rh " _............ ......._.............. .-....................................... ................ ............. . I....................... ,.................. ..... . .. . .................................. ...................................................................... 8th do ......................................__............................................................. ............. ........ ... ......., ....... . ........ ..............I . ............. .. .... ................ ...................... 9th „ _. . ............. . ........................... Material.of Front? ...If stone, what kind? Thickness of Ashlar? Thickness of Backing? ...... Backed up with what? Arches or lintels over openings? WOOD CONSTRUCTION. Giv Size, Longest Span and Distance Between Centres, of Joists, Girders and Columns JOISTS 11 GIRDERS COLUMNS Floors Size Longest Span Centres Bridging Size Longest Span Centres Sim Length Centres -t 1st Floor ...... ............... j X'(0-0 -iff.....................................i ........................... 7.............................. ........ A0............................ .... .. -7 2nd............. V o ...... °�..... _............................_.. _....._.._.. __.... ............_....w 3rd is .f.. 4 .... ..... ....... .......... .................. _............. ................................ _.._..... ................ _.._.....�. _.........._. w Size of outside studs? ..... ............ Distance on centres? 16 x.... ... ........... .... .............. Sue of sill. Size of rafters? ...,.2.�c....�. Distance on centres?........ ... �P .. ...... Size of plate? ................. . rZ .... 0000 A Size of ledgers or girts? .. ........ ....... ........................Size of deck rafters? ................................................................... ............... w 00 Distance on centres? ............ ......................................................................Size of studs in bearing partitions? ....... .. x... .................. MISCELLANEOUS Style of roof, flat, pitch, Mansard, or hipped? . ...... Fireplaces? ............©. ....... Material of roof covering? of Cornice? .......... m.© ................. ..................... How is building heate ? .v.� .! ?7;d7g! Lining of flues? ........... ~......................................Any elevators or lifts? ...................... ... Thickness of shell of flues. . ..........,�........ ......................... .............. . What kind? How many? . . ... .. .... ... .. Any hoistwa ? . ..... ... ... . .......... . ........... . How protected? ............... ................................. . ...............Total Value of Building ... .. !...��y...L?o--'o..................... r � When will work be commenced? .. trt�.N U.k .. . Ems'. .�..7.'".../.'•5............... The applicant warrants that the lot for residential purposes, shown on a plot plan accompanying this application, conforms to the zoning regulations of the Town of South Windsor. Town of South Windsor since 1949. U.ZPA R. HOU.51NG COMP ATION Applicant 6202 BUILDING APPLICATION Application No. ..-.6.4.7.2...................................................... ............. south on the ........................................................................ ...... side of .... ..........S.C.?t.t. Drive .. ..................... Street. ... ..... .... ....... .. . Street No, . #12..8....... Owner .U...& .R... H.o u.s.i.ng....C..o r p......... Applicant Same. .... ........ CLASSIFICATION Dwelling 64fx261 ........ .. ................... . . .. . ............. ......... Permit issued on above Application. 11-27-67 Date, . .. .. . . 19... . . TOWN OF SOUTH WINDSOR BUILDING PERMIT Date Nov.27, 19 67 Fee Paid �$ 92,00 Est. Value �$. 23. 000 20.00 RF'1 ', c-ws-rA{^ ��T� xr..s. .......... Permit 6202 on the South side of Scott Drive Street Street No. Lot #12 8 . r/ 9 i Owner U & R Housing Corp. Applicant Same -� CERTIFICATE OF OCCUPANCY ISSUED: a Date No. 3579 p Fee Paid $ 3 .0 0 CLASSIFICATION Dwelling 641 x261 i I l 4 BUILDING PERMIT N° 6202 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. Nov.27o 196 3 94is to to Terftfil, That I R flougi= Co". is hereby granted permission to PWa114.nEr, 64 t y.?_'f at estimated value of $ on the South side of So ott Dr ive t L:)t #128 Street on land ' owned by U Said to be as described in Application No. f72 and to conform to specifications and plans filed with said Application, and Building By Laws of THE TOWN OF SOUTH WINDSOR. I Issued ail``�''��, -�- 1967 Building Inspector: i Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: `When any person shall, place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." 11-27-67- INSPECTION REPORT U8cR Housing torp Permit # 6202 Jot7&R Housing Dwelling Lot#la 1 Footing f 47 Scut Drive 2 Foundation 7- 3 Framing 4 Wiring 5 Plumbing 6 Heating 7 Lathing 8 C.O. #3579 Permit No. 4) 70� TOWN OF SOUTH WINDSOR SOUTH WINDSOR, CONN. Permit No 3579 Certificate of Occupancy IS IS O RTIF that t at No. in the T wn of South Windsor, Connecticut, has been erected and completed in accordance with the Building Code and Zoning tions of the Town of South Windsor, and is hereby approved for occupant /, ? Building Inspector Owner, Builder Fee PaidIle—), Date 19 4 r 125 2?. 73' { i F ins z � 0 0 0 0 0 N CG.4 ?G' 31't i aq� 95.28' 5COTT DRIVE PERMIT PLAN LOT #12819 "BIRCH HILL ESTATES", SECTION #6 TOWN OF SOUTH WINDSOR, CONNECTICUT SCALE: 1" 40, t # 4395 Rockville, Conn. APPLICATION FOR PERMIT TO DO ELECTRICAI. WORII. 11 t17 No. .. ... ..45�6..... . Permit No. . . .. .41-9.5........ TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. ................. hereby make application tq perform Electr cal Work according to detailed description below. All provisions of the Rules for Electrical Installation, Section 48, Building By-Laws, shall be complied with whether specified herein or not. South Windsor, Conn., ........ .�45 . .. 144FSign here ,d[.�, .�/` - j... ..... - `..... .. Address 12. .CF. Location ....... ..... .. ...!'/yr0 Side of Nature of Building ........ . . How many stories .............. .... ......................................................................... New or old Building ......... How many families ....... .. ..........I....... ... ...... ....................................... Kind of Installation ,�d"w� .............................. �,/'...` How many Stores ......................................... C .... Address ........ . '..... "a "`...... ...................Owner .. .... .... ...Architect ..............................._................................................ .... ... ... ... Address Builder . .....�„. . Address ' ....... .... ..... ..... ............. 4 Electrician . . .. . . ...............���� ....� Address 1,zza-...�.... �.. ��.. ' r� /jo� Size of Main Wires ... ..........;0.........?�..................... No. of bight Loops .. ...... .../ No. of Heat Loops .. . / No. of Power Loops ......................................... No. of Light Outlets .... ../ . ... No. of Heat Outlets ..... l No. of Power Outlets ........ ... .. ... .... . No. of Light Circuits ... No. of Heat Circuits No. of Power Circuits .. No. of Sockets . .. . . .. No. of Heat Receptacles No. of Motors No. of Panels ............. ..... ./. .. Size of Heat Circuit 4 No. of Power Receptacles No. of Switches ...... Total Wattage .... .. .. Size of Power Circuit .. .. . . Total Horsepower .. . .. ..... No. of Straight Electric Fixtures ... . No. of Combination Fixtures . No. of Receptacles ..................... ... No. of Cord Drops . Remarks: For other kind of In tallation . ........... ... . .............. . ............ ... .................... . .... .. ..................... ............. ................................................fry...... ..... ........... .......... ...... ......... ........ ........ ............. ........... ......... .. ...................................................... r ... ... ...... ... ... ... ........ ..._............................................ .................................... ............... ....... ............ . i ,y ................................................ ... ,..� .y...d`.. Al ......... ........ ......... .. .. .. ......... Estimated Cost ...... ...,JOL - . . 3633 r 0 PLUMBING APPLICATION i Application No. 3422 on the......_...._ ,1 We of Street No. Owner .... r Plumber _ ..: Filed in of The Building Iarpecaor 1-24-68 19 No person shall commuct, add m or aher my portion of the drainage system of any boUng (except to repair leaksy until a Permit is granted by the Building Inepecanr. 6 � V Application No. ....34.22 ..................... Permit No. 3633 71 ............................. TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. .....hereby make application to perform plumbing according to detailed description below. All provisions of the Rules for Sanitation, By-Laws, Sections 33 to 47 inclusive, shall be complied with, whether specified herein or South Windsor, ....................... 1� Sign .here ..... Address ........ ....... ................................. ........................... ...... Street Location . ........ ........................... side of ............. ..... .. Natureof Building ........... .. . ... ...................... ............................... How many stories .. ................................................................6.........I............ ........... Owner ......................... Address .......... ........................................ Architect ................................. .................... Address .......................................................................................6............................ Builder .......... .................................. .............................................. Address ........................................................ Ir .... Address .......! e..... ..... .:5v).....1?/-, Plumber ........ . . ...............................6................ DRAINAGE Z? .................................... ............. . CESSPOOLS, How many Where located ................................................................66.............................. Are they water tight ........ ................ Of what materials are they built ..... ....... Size of pipe from house to C#.l . ......��/- . .... ............. Kind of pipe ....... /. ....................................................... ................ MAIN DRAIN IN CELLAR, Material .... Diameter ......../......***---*--"...........6............. Aboveor below cellar bottom .. ....... .... . .10...................... .. ... . ..................I.......6..........................................6........................................I.......... 7— SOILPIPES, Material . ........ Diameter -//...............................6..................................................................... WASTE PIPES, Material . .. . ............... . .............. . Diameter �................ '�L 3 ......................-...........................6........... .............. TRAPS,Type proposed to use is .. .......................... . ... ... . ........................................................................6..........................................6................... RAINWATER LEADERS, where do they run to .............. . . .....................................6................................... ........................ ..........6..... REFRIGERATORWASTES, where do they run to . ... .. .....................................................................................6. ........ ............................... TANKOVERFLOWS, where do they run to .................. .... ...................................6........6......................6..............6............... FIXTURES 122- WATER CLOSETS, How many ....... ........0................. .......... Where located ................. .............................................. ............................................................ Distance from trap to vertical soil pipe ....... &.................... Pattern WASHTRAYS, How many ..... ................................................ Where located . ..................................................6.....................6...... SINKS, How many ................ .. .....................*,,/* ,,***,**,*,,*......*........... . Where located /. A "(-*...*...­...­­­...**­­­*­****......... BUTLER'S SINKS, How many ........................................................ Where located. ....................................................­1.......................6..................... REFRIGERATORSINKS, How many .. ..............6...6................ Where located ............... ........................................................66..................... LAVATORIES, How many . .....................d................................ Where located ..................................................................... BATHTUBS, How many ........................../...................................... Where located .......... ........................................................................ URINALS, How many .................. .. .................................. .......... Where located .. ...... .................................................................................... Are water closets and urinals to be local vented If not, is there a window in outer wall ofroom where sa7m are to be located . . .. ................................................................................................ ......I............... Estimated Cost. ............................................. PERMIT # S Application For 3458 DEPARTMENT DECISION Cd 3679 Heating Permi t �: APPLICATION IS HEREBY: O O DEPARTMENT OF LICENSES AND INSPECTIONS N QCAPPROVED 10 DISAPPROVED TOWN OF SOUTH WINDSOR 1-24-6800 s . ' DATE CHIEF INSP O APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL W O o � 1. LOCATION OF JOB q = NO. STREET 4Cd v LOT NO. FLOOR APT. NO. O p p 2. OWNER ce � o Z o S. ADDRESS bo I ; 4.PHONE s. APPLICA vi 0 10 •0, ,w a. ADDRES Cd �+ Cd 7.PHONE i w 0 1s. LICENSE N0. dl�s o w +' 9. EXPIRATION DATE OF LICENSE c� C to. ESTIMATED COST s � o bID t 1. IS THIS A CONTRACT COST? ❑ YES ��NO ,0 PIZ 12. FEE ENCLOSED S v 1s. TYPI OF BUILDING: O0bo RESIDENTIAL ❑ COMMERCIAL .. .9 as 3 14. TYPE OF JOB: ❑ INDUSTRIAL �iI IGINAL ALTERATION # ~ INSTALLATION ❑ ADDITION REPAIR /J 2 1/ APPLICATION FOR HEATING PERMIT (Continued fr m Reverse Side) "Y 11. LOCATION OF JOB Z / '�-e- (p NO. - STREET FLOOR APT.NO. 12. TYPE OF INSTALLATION: L_7 OIL BURNER LJ HEATING SYSTEM ❑ VENTILATION ❑ SPRINKLER ❑ GAS BURNER ❑ STACK ❑ INCINERATOR ❑ MISCELLANEOUS IDENTIFY SIZE / ` SIZE 13. OF TANK �/ OFCTANKN ,(tG OF FILL `'�_ OF VENT 14. B.T.U. EQUIP. AT REGISTER URNACE MAKE AND 0. AT BONNET //FIRING RATE BOILER OR FURNACE MAKE AND N0. Ul�t:(1. OR SQ. FT. NET q fZ B.T.U. OR SQ. FT. G R 0 'FIRING RATE FLOORS TO BE HEATED f NEW OR OLD BUILDING INSULATED - YES OR NO TYPE OF WALLY / INSULATION ROOF OR CEILING INSULATIO AVG. SYSTEM WATER TEMP. ! d U B.T.U./SQ. FT./HR. EMISSION INDOOR-OUTDOOR TEMPERATURE DIFFERENCE _ /r - :761 'FAHRENHEIT MAKE OF RADIATIO BASEBOARD COPPER CO VECTORS, OR C.I. RACIIATION. OUTPUT PER CTION OR LINEAL OF RADIATION. SQ. FT. OR B.T.U. fr t� y C,!% DESCRIPTION WORK 15. TO BE DONE: 16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS): ROOM SIZE WINDOWS AREA - SQUARE FEET B•T•U• B•T•U• DISTRIBUTION INSTALLED AND DOORS VOLUME TOTAL TOTAL u1 ROOM NO. GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED J j LL REGISTER L W H AND Ir TEMP. TO F TYPE AND SIZE RAD. OR LEADER SIZE < WALL Gt0 (INFILT.) DIFF. •F O m a SQ. FT. FREE AREA -v 0 3 r??2o kim WWV / /o 2 _z TOTALS �} A. HEAT LOSS FROM BUILDING `� �U y B.T.U./HR. B. DOMESTIC HOT WATER DEMAND B.T.U./HR. C. PIPING. OTHER THAN NORMAL B.T.U./HR. ALLOWANCE FOR HEAT VALVE FUEL (A B C) FACTOR 17. ELECTRICAL WORK BY. NAME ADDRESS SUBCONTRACTORS AND 18. THEIR TRADES ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE UIWING CODE. APPLICATION TO BE COMPLETELY FILLED IN. /`�� D E SIGNATURE OF APPLICANT 2168 OIL BURNER OR FUEL STORAGE APPLICATION Application No. 2179 Permit No. 2168 on the side of Scott Drive Street Street N C ' Owner Application J•Ve d cv a t o, CLASSIFICATION American Std. Permit Issued on Above Application 1-30-68 Date 19 Fee Paid $ Permit #6202 TOWN OF SOUTH WINDSOR 7 71rf V�, 0� APPLICATION TO INSTALL RANGE AND FUEL OIL BURNERS EQUIPMENT AND TANKS PERMIT N . 2168 DATE I A!:�? The undersigned hereby applies for a permit for the installation of range and fuel oil burners, equipment and tanks of the following descriptio Address.` - 1��" -C-l�J 1st floor 2nd floor _ 3rd floor Character of Building: Frame !/ Brick Owner of Burner v J i Owner of Building " e-4 Lessee or Tenant__ RANGE BURNERS Capacity of Tank at Range--- in cellar outside Name of Range Burner _ Purchased from POWER BURNERS Name of Fuel Oil Burner _ / ' Model Number _ Purchased Name of Tank _ Gauge of Tank Where is Tank Locate Size of Tank _ Size of Motor Size of Wire Will other heating equipment be installed? If so, by whom Name of Party Making Installation Address y�Gl Electrician Address JSigned -� - APPLICANT All provisions of Ordinances of this Town Regulating Oil Bu er Equipment and Fuel Storage (Sections 1-23 in- clusive) and Underwriters' Code applicable to the subject matter of same shall be complied with in execution of thiQ work whether specified herein, or not. Estimated Cost $ � Application for Permit received 1-3 0-6 B and Permit No. 216 8 issued l- 0-6 8 J Permit_ #6202 A roved � Permit Fee Paid __—_P_ _ PP - " BULL IQG IN�PEC,fOR DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT PROVE 1540 SULLIVAN AVENUE Bldg.Permit# t� -�3 A— 644-2511 ext. 230 Date Building Inspector Application must be printed or typed Location of Job: FEE SCHEDULE /d sc O $0-$1,000=$13.00 treet No. Street Lot No. ' Over$1,000= $13.00 per$1,000 ' or any fraction thereof Tenant Designation Apt.No. E APPLICANT /44 1-c 6V S O APPLICANT ADDRESS '50, W i ids 0 t- cT APPLICANT PHONE# '"07K6 OWNER /-- PfJ�r���f � 'C OWN S F-4 OWNER ADDRESS �/l� SC d '�"� • • 5vy OWNER PHONE C ESTIMATED COST$ �3"-90 0 •00 IS THIS A CONTRACT COST? O Yes� �3 f �! FEE ENCLOSED$ 9 00 Spg CO TYPE OF JOB: . ew Installation O Alteration/Addition/Repair Revised 8/99 APPLICATION FOR HVAC PERMIT (Continued from reverse side TYPE OF SYSTEM: TYPE OF BUILDING: CHEATING ❑RESIDENTIAL ❑A/C ❑COMMERCIAL ❑VENTILATION ❑INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. dR44YDRONIC ❑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) DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.) ;�, Xe 7-e5:-O le( - C/ GROSS HEATING CAPACITY(INPUT—BTUH) f S��i Ors NET RATING(OUTPUT—BTUH) o TYPE OF FUEL ❑ 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 c /c-;� Zcoc--A' /e/ '9 a 'A 4/t-/�/d, 44,7. ra,"fl. I 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. �0173Z f C7 -" CONTRACTORS LICENSE NO. E STATE SIGNATURE OF APPLICANT DATE 9 D DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT# Application is hereby: TOWN OF SOUTH V4NDSOR BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date Building Inspector Application must be printed or typed �� Location of Job: FEE SCHEDULE jg / / sco�-k e , $0-$1,000=$13.00 et No. Street Lot No. Over$1,000= $13.00 per$1,000 or any fraction there o Tenant Designation Apt.No. AP ICANT /Q di'es../S 4 /'! I PLICANT ADDRESS f-?CC r-1 0(0 X/ G l AD 0� �- APPLICANT PHONE# W N OWNER Ox OWNER ADDRESS ��9 S�'O �" 5"67 r !� Sa---L •a �' F, OWNER PHONE C ESTIMATED COST$ -3 -'5D0-,0 IS THIS A CONTRACT COST? 0 Yes K No 1� ICJ FEE ENCLOSED$ 00 TYPE OF JOB: 9 OR-Co RMew Installation 13 Alteration/Addition/Repair Revised 8/99 I APPLICATION FOR HVAC PERMIT (Continued from reverse side TYPE OF SYSTEM: TYPE OF BUILDING: ❑HEATING ❑RESIDENTIAL ❑A/C ❑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 'U 0 ❑ 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 DESCRIPTIO OF WORK "S A"f 1-1 17e ct/ '3_00 a( .V s4 1n �O lei • THE UNDE SIGNED 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. 3c :y 7- CONTRACTORS LICENSE NO. E STATE y SIGNATURE OF APPLICANT -- DATE