HomeMy WebLinkAbout191 Bourbon Street (15) DEPARTMENT DECISION
APPLICATION FOR HVAC PE PERMIT#
RMIT 16 3 4jq 14
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE
<Y 644-2511 ext.230
Date Building Inspector
Application must be printed or typed
Location of job
I-a-bow 1;
Street No. Street Lot No.
FEE SCHEDULE
$0 - $19000 - $12.00 Floor Apt. No.
Over $1,000
$12.00 per$1,000
or any fraction thereof OWNER Mx ax
ADDRESS T
. so c�,,wdsG�.
OWNERS PHONE# q I
APPLICANT
5 le
OW St 4 ADDRESS
ESTMATED COST $
IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $
36 60
SQ.
R-CO TYPE OF JOB:
Original Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING � RESIDENTIAL xf
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC X 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 EQUIPMENTEQUIPMENT (INCLUDING MAKE&MODEL NO.)
(AIL n4c'1-,KI v G 6- � c� � l7 W cxST I(Z0V CGL �
I �'
GROSS HEATING CAPACITY (INPUT-BTUH)/96 ut"NET RATING (OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM GAS-INPUT ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
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 ►� GH t S -7 y'Uoo L
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.
J
STATE LICENSE-NO. NAME&TYPE SIG ATURE OF APPLICANT
/)P c-
PHONE NO. � �—�9r�� DATE / 1��
INSPECTOR C.--J DATE Z 3 TIME
LOCATION I l V M
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
PLUMBING:
HVAC: I V -
105qq
F
OTHER:
F
F