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Application For
DEPARTMENT DECISION 34o6 Heating Permit
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3 APPLICATION IS HEREBY: DEPARTMENT OF LICENSES AND INSPECTIONS
N KI APPROVED ❑ DISAPPROVED
TOWN OF SOUTH WINDSOR
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00 a) DATE 'CHIEF INSeECTOR Y tee- _� I APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BELOW
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.0 1. LOCATION OF JOB
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NO. STREET
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i LOT NO. FLOOR APT. N0.
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PLICANT <J l/vwv -
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LICENSE NO.
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+; 9. EXPIRATION DATE OF LICENSE
10. ESTIMATED COST =
IS THIS A CONTRACT COST? IJ YES ❑ NO
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.� Pest #5504
z3 12. FEE ENCLOSED S
13. TYPE OF BUILDING:
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col rn ❑ RESIDENTIAL ❑ COMMERCIAL
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Cd y 14. TYPE OF JOB: ❑ INDUSTRIAL
ram-+ ❑ INSTALLATION ❑ A RIGINAL ALTER DITIONON
REPAIR
APPLICATION FOR HEATING PERMIT Continued from Reverse side
V 'k"� 11. LOCATION OF JOB
Cn� NO. STREET FL 01W APT.NO.
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12. TYPE OF INSTALLATION: ❑ OIL BURNER HEATING SYSTEM VENTILATION ❑ SPRINKLER
E GAS BURNER ❑ STACK ❑ INCINERATOR ❑ MISCELLANEOUS
IDENTIFY
SIZE LOCATION SIZE SIZE
13. OF TANK OF TANK OF FILL OF VENT
AND NO. A
TE
14 BOILER OR FURNAlAK AND N0. Z BeT.0 OR SQ. FT. NETlT.UOORESQ. FT. GROSS-FIRING 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. SQ.
FT. OR B.T.U. //
15. DESCRIPTION OF WORK �'�yy� �7'e t`-i' ej /,-7 4/$J Z7/ 4,1 r• ` �' 7-7 G,'
15. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
ROOM slzE INDOWS B.T.U. B.T.U. FD- DISTRIBUTION INSTALLED
AND DOORS AREA - SQUARE FEET VOLUME
TOTAL TOTAL yl
ROOM NO. GROSS GLASS NET WALL CEILING FLOOR CU. AT 70•F CORRECTED t j 4 LL RAD. REGISTER
L W H AND E TEMP. TO <F TYPE AND SIZE OR LEADER
SIZE < WALL to (INFILT.) DIFF. •F m a SQ. FT. FREE AREA
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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:
NAME / ADDRESS
SBCNTRACT
18. THE ROTRADESORS AND "/ S SLC� ✓�S. Iy/L!C�I�C,�I /�
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF HIS PROPERTY AND WILL
BE DONE IN STRICT ACCORDANCE WITH THE BUILDING C DE.
APPLICATION TO BE COMPLETELY FILLED IN.
ATE SIGNATURE OF APPLICANT