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PERMIT #
Application For
DEPARTMENT DECISION 3330
y 3 551 Heating Permit
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APPLICATION IS HEREBY:
0 DEPARTMENT OF LICENSES AND INSPECTIONS
N APPROVED ❑ DISAPPROVED
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1-4
Ca 3-6-67
00 O O DATE CHIEF IN OR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL W
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1. LOCATION OF JOB
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LOT NO. FLOOR APT. NO.
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0 w 9. EXPIRATION DATE OF LICENSE
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10. ESTIMATED COST t =J� Cl •C1C�
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IS THIS A CONTRACT COST? 13 YES ❑ NO
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Pzxmit #5832
12. FEE ENCLOSED S
C) 19. TYPE OF BUILDING:
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ORESIDENTIAL ❑ COMMERCIAL
� 14. TYPE OF JOB:
IL.I INDUSTRIAL
❑ RIGINALALTERATION
INSTALLATI N Ef A
/' REPAIR
ti (Continued it m Reverse Side
APPLICATION FOR HEATING PERMIT
/ 11. LOCATION OF JOB 00
NO. STREET FLOOR APT.NO.
12. TYPE OF INSTALLATION: ❑ OIL BURNER ❑ HEATING SYSTEM ❑ VENTILATION ❑ SPRINKLER
❑ GAS BURNER ❑ STACK ❑ INCINERATOR MISCELLANEOUS� ��, A Q4�
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. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO. B.T.U. OR SQ. 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. SQ.
FT. OR B.T.U.
DESCRIPTION OF WORKe
15. TO BE DONE: �V lhl l C�1�5j1K_ y"
16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
ROOM slzE WINDOWS AREA — SQUARE FEET B.T.U. B.T.U. F DISTRIBUTION INSTALLED
AND DOORS VOLUME TOTAL TOTAL y
ROOM NO. GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT TD•F CORRECTED -J j LL LL REGISTER
L W H AND K TEMP. TO F F TYPE AND SIZE RAD. OR LEADER
SIZE ( WALL f'�tc (INFILT.) DIFF. •F O m a Sq. FT. FREE AREA
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
SUBCONTRACTORS AND
t8. 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.�� C
DATE SIGNATURE OF PLICANT