HomeMy WebLinkAbout169 Brookfield Street (11) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT I(j-7C)--?
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE ex--6-MkC;-4.
Location of Job:
S�-
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Ap:No.
APPLICANT RQb 11"l-k s TEA p Pam, _A(-.
APPLICANT ADDRESS
E I I 14V ,ra 4-4 C.-�- o(, 0 29
APPLICANT PHONE#
OWN S OWNER b A� v 10
to*
OWNER ADDRESS —IL
rrww '; o7JT1� �1►A Se�
OWNER PHONE L 4 ' 8-)S 4
EST MATED COST$
�1 U
IS THIS A CONTRACT COST? A Yes 0 No
ICJ FEE ENCLOSED$ c `7
��
OR COTYPE OF JOB:
s .
O New Installation
13 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF BUILDING:
bk HEATING CrRESIDENTIAL
❑A/C ❑COMMERCIAL
❑ VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION a-a_ 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.)
M odc,l M ca'! pt—
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT BTUH)
TYPE OF FUEL
❑OIL—GPM OIL TANK LOCATION:❑INSIDE❑ OUTSIDE CAPACITY
X 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 LAJ 2 094--r1-3 ct ml J
THE UNDERSIGNED HEREBY APPLIES 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.
s 3 $sV 0 s t Cf
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT �!4�
DATE 19' d o