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PERMIT #
Application For 4985 4784
DEPARTMENT DECISION permit
3 APPLICATION IS HEREBY:
DEPARTMENT OF LICENSES AND INSPECTIONS
N RAPPROVED ❑ DISAPPROVED ;
. ! TOWN OF SOUTH WINDSOR
o ,, 4/19/78
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00 DATE CHIEF SPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BELOW
c (1) 1. LOCATION OF JOB
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NO. STREET -
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Ila: 4 LOT N0. FLOOR APT. NO.164
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�, B. EXPIRATION DATE OF LICENSE
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0 10. ESTIMATED COST s
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'-' 11. IS THIS A CONTRACT COST? 2 YES ❑ NO
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12. FEE ENCLOSED $ Permit 10199
is. TYPE 0 BUILDING-
RESIDENTIAL
RESIDENTIAL ❑ COMMERCIAL
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3 14. TYPE F OB: ❑ INDUSTRIAL J
W1,0010RI INAL + ALTERATION
INSTALLATION ❑ ADDITION
REPAIR
APPLICATION FOR HEATING PERMIT (Continued fr m Reverse Side)
11. LOCATION OF JOB I-I "� X
NO. STREET ° ' FLOOR APT.NO.
12. TYPE OF INSTALLATION: ❑ OIL BURNER ❑ ELECTRIC ❑ VENTILATION ❑ SPRINKLER
~wp lJ GAS BURNER ❑ STACK ❑ INCINERATOR 1❑ MISCELLANEOUS IDENTIFY
SIZE LOCATION SlZE SIZE
13. OF TANK � _--OF TANK ,.� 8F FILL ' OF VET
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE ANip NO. AT BONNET,�� FIRING RATE
BOILER OR FURNACE 1 AKE�ND NO. B.T.U.'Oft SQ. FT. NET,_,��B.T.U. OR SQ. FT. GROSS FIRING RATE
FLOORS TO BE HEATED NEW O J.D,BUILDING 7 w INSULATED — YES OR NO
TYPE OF WALL INSULATION 4(00F OR CEILING INSULATION
AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HkR. EgIISSIOf-
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE � °FAHRENHEIT
MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS.Ol! 01. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U. '"
DESCRIPTION OF WORK «
IS. TO BE.NONE:
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tIs. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
ROOM slzE wlNDowa AREA — SQUARE FEET e.T.u. e.T.u. DISTRIBUTION INSTALLED
AND DOORS VOLUME TOTAL TOTAL
�LL
R OM NO' GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED J j RE ISTER
L w H AND E (INFILT.) TEMP. TO F f a TYPE AND SIZE SO.
O AFT.
F• OR LEADER
SIZE < WALL f'L-TO DIFF. •F f m N FREE AREA
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TOTALS r"`
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
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17. ELECTRICAL WORK BY;
NAME ADDRESS
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. JhTkM
APPLICATION TO BE COMPLETELY FILLED IN. � aA
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DATE SIGNATURE OF APPLICANT