HomeMy WebLinkAbout142 Benedict Drive (3) DEPARTMENT DECISION PERNUT:9
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APPLICATION FOR HVAC PERMIT
Application is hereby TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT BIdQ P remit#
APPROVE 1540 SULLIVAN AVENUE
644-2511 ext. 230
n ate ,ding Inspector Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE Floor Apt. No.
L $0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER ;,P
or any fraction thereof ADDRESS
ft-04J 14 A)14
OWNERS PHONE#
APPLICANTOW S� -of/ Z 7zee
ADDRESS
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ESTIMATED COST $
0
IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $
SCR CO ME OF JOB:
Original Installation
Alteration/Addition Repair�����
Revised 11/95
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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 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 CAPACITYS LPG TANK CAPACITY
c 2 le
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
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN. ING CODEZINE
PERFORMANCE OF SUCH WORK.
STATE LICENSE-NO. NAME&TYPE SIGNATURE OF APPLICANT
PHONE NO.Z� -Sf 6/ DATE '- o2/`9y