HomeMy WebLinkAbout11 Andries Trail (7) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: /0 Q,2- S/
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
2 l6 �o ��� 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
F
s 7,2,
$0-$1,000=$13.00 Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof nation Apt.No.
APPLICANT
APPLICANT ADDRESS 3
APPLICANT PHONE# 8•D 7,d6 6
��W N SFq OWNER ��o 7o.r�.o
OWNER ADDRESS
OOWNER PHONE 6 yy- 90O S
C ESTIMATED COST$ 800.o0
* IS THIS A CONTRACT COST? ®Yes 0 No
�G FEE ENCLOSED$.So7• DD
r��SOR Co TYPE OF JOB:
0 New Installation
Iff Alteration/Addition/Repair Revised 8/99
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF BUILDING:
Ja HEATING 9 RESIDENTIAL
❑A/C ❑COMMERCIAL
❑ VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
JS HYDRONIC ❑ WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ' ADDITIONAL RADIATION TOTAL RADIATION &O"9 Tl)
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
•-��/fc�/ 77i'-�Q i h i/�A'ii'ci-f Ti/'�d ,/,IiGL rc/" /7ia fY� �l7eGl�c/(��/���v s /!�
GROSS HEATING CAPACITY(INPUT—BTUH)/ys„`x) NET RATING(OUTPUT—BTUH) 1,76 dao
TYPE OF FUEL
B OIL—GPM/a0 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 ter, ifti />vi�'
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. /�
3 9-5-8- 7 S. ( /1 PXb -2-000
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE / .2 • 7 9 9