HomeMy WebLinkAbout185 Brook Street (5) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT �/aC112 3
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANTA�Jlagt-
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APPLICANT ADDRESS 70 1--Oe�e
APPLICANT PHONE#
OWN S��4 OWNER
OWNER ADDRESS ��o
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6 7 y f
1 L
OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? 13 Yes )(No
FEE ENCLOSED$ - Z9 C3
TYPE OF JOB:
soR.Co
New Installation
0 Alteration/Addition/Repair Revised 8/99
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APPLICATI ;HVACC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF BUILDING:
❑HEATING ��i2 L XRESIDENTIAL
❑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 OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) °F(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
.DESCRIBE ,ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
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GROSS HEATING CAPACITY(INPUT—BTUI) NET RATING(OUTPUT BTUH) 33�
TYPE OF FUEL
❑OIL—GPM OIL TANK LOCATION:❑INSIDE❑OUTSIDE CAPACITY
•�• GAS—INPUT LPG TANK CAPACITY =� ELECTRIC—KW
AIR CONDITIONING
DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF
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�' �e 4
S s c� •
THE UNDEASIGNElf HE B PPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
3 3
CONTRACTORS LICENSE NO. TYr — STATE
SIGNATURE OF APPLICANT DATE d