HomeMy WebLinkAbout18 Andmar Lane (9) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT 1� #
1�
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Pe it#
fic, �
1540 SULLIVAN AVENUEr 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
a Location of job
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER
or any fraction thereof /�
ADDRES �� 161 1411 caG Cc
OWNERS PHONE#
APPLICANT
Ow gf ADDRESS
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ESTIMATED COST $ ,/O0
IS THIS A CONTRACT COST?
YES NO
J&
C! FEE ENCLOSED $
O. C0 TYPE OF JOB:
R. Original Installation
gyration/Addition/Repair
Revised 11/95
APPLICATION FOR IIVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING �� RESIDENTIAL y '
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 F INSIDE F DIFFERENCE F
TOTAL HEAT LOSS(BTUH)
(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT (INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY (INPUT-BTUH) 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 �� O
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
0�3 62 —r/
STATE LICENSE-NO. NAME&TYPE jSIGNrk4RE1 OF APPLICANT
PHONE NO. �4/%2.1'3 DATE L.�G{ // 9