HomeMy WebLinkAbout1733 Ellington Road DEPARTMENT DECISION PERMIT#
APPLICATION FOR HVAC PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPRO)o 1540 SULLIVAN AVENUE /Y Ro
644-2511 ext.230
Date Building Inspector Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER
or any fraction thereof ADDRESS FI -33 E)-L TO tJ
CT
OWNERS PHONE#
APPLICANT
OW N ADDRESS
<
ESTIMATED COST $
IS THIS A CONTRACT COST?
mow YES NO
FEE ENCLOSED $
E OF JOB:
OR- 0
Original Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING RESIDENTIAL
A/C COMMERCIAL d�
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 F INSIDE F DIFFERENCE F
TOTAL HEAT LOSS(BTUH)
(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 GAS-INPUT ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY2`/C-�A:? Ge?�
AIR CONDITIONING
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
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 I/V
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
l 3c;>J7 5�A/?J��c��
STATE LICENSE-NO. NAME&TYPE SIGNATURE OF APPLICANT-
PHONE NO.O' DATE III- -'Z e9
STAR GAS SERVICE
64 OAKLAND AVENUE
EAST HARTFORD,CT 06108
(860)528.1030
(860)291.1748(FAX)
municipality: ���%T C'�`� S?L
Job Name: Start Date:
Address:/J:/3 znzz iw6%-Jeif
Job Description: //JELL- v2 / ®
Per Public Act 91-95
This letter authorizes to
sign the job permit as an agent of Star Gas Propane for the above
mentioned job.
outure C Lic. #G1-308774
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