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9 Application For
A lie DEPARTMENT DECISION 3 713 Heating Permit
3 APPLICATION IS HEREBY: DEPARTMENT OF LICENSES AND INSPECTIONS
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I N APPROVED , ❑ DISAPPROVLQ
. �. TOWN OF SOUTH WINDSOR
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5-16-68 /;
00 DATE C — APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL W
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o 1. LOCATION OF JOB
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NO. STREET
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Cd LOT NO. FLOOR APT. NO.
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1 J -� S. LICENSE NO. f✓� �
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c w s. EXPIRATION DATE OF LICENSE
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� o _ 10. ESTIMATED COST S T— �y
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11. IS THIS A CONTRACT COST? ❑ YES ❑ NO
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,=s 12. FEE ENCLOSED S 2.00
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CO m TYPE OF BUILDING:
W RESIDENTIAL
❑ COMMERCIAL
c 3 14. TYPE OF JOB: ❑ INDUSTRIAL
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NSTALLATION / A DEITIONON
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REPAIR
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APPLICATION FOR HEATING PERMIT (Continued tr m Reverse Side)
11. LOCATION OF JOB
0. STREET FLOOR APT.NO.
12. TYPE OF INSTALLATION: ❑ OIL BURNER 2/HEATING SYSTEM ❑ VENTILATION ❑ SPRINKLER
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❑ GAS BURNER ❑ STACK ElINCINERATOR ❑ MISCELLANEOUS �LLL
IDENTIFY
SIZE LOCATION SIZE SIZE
13. OF TANK OF TANK OF FILL OF VENT
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO.7� &Iycj AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO. B.T.U. OR SO. FT. NET B.T.U. OR SQ. FT. GROSS FIRING RATE
FLOORS TO BE HEATED NEW OR OLD BUILDING INSULATED - YES OR NO
TYPE OF WALL INSULATION ROOF OR CEILING INSULATION
AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE 'FAHRENHEIT
MAKE OF RADIATION: BASEBOARD, COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SO.
FT. OR B.T.U.
DESCRIPTION OF WORK
1s. TO BE DONE:
is. 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 �n
ROOM NO. GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED -J j LL REGISTER
L W N AND E TEMP. TO t <F TYPE AND SIZE RAD. OR LEADER
< WALL f'� c r
(INFILT.) • F m uai SQ. FT'
SIZE DIFF. F FREE AREA
75<
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TOTALS
A. HEAT LOSS FROM BUILDING 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 OF FUEL (A B C) FACTOR
17. ELECTRICAL WORK BY: 94/? /--L 9 L ANAME �jo&!' ADDREco yy'`w
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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 BUILDING CODE.
APPLICATION TO BE COMPLETELY FILLED IN. / y (1 r/
IIIATE SIGNATURE OF APPLICANT