HomeMy WebLinkAbout100 Arnold Way (53) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PE
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Application is hereby TOWN of SOUTH WINDSOR j,0 101�
BUILDING DEPARTMENT Bldg Permit #
APPROVE 1540 SULLIVAN AVENUE
�X 644-2511 ext. 230
3
Date Building Inspector Application must be printed or typed
Location of job
100 A(aA30),b vjky, Y 6bwmlt;�s A,"bLd
Street No. Street Lot No.
FEE SCHEDULE
$0 - $1,000 - $12.00 Floor Apt. No.
Over $1,000
$12.00 per$1,000 OWNER 0
or any fraction thereof
ADDRESS
OWNERS PHONE# 6+1-2-5)(
APPLICANT 'Rrzo - Mif-r-RLUC. Z;:�WMCf 'i;kDAJ
Ow 8,0 ADDRESS 402 r?"g-li Qwea-
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-7f�:�L*t$K4 F I Ot.- 06 Z
ESTIMATED COST $ 0 o o
IS THIS A CONTRACT COST 9
. —Z—
ANN YES NO
FEE ENCLOSED
OR-C /TYPE OF JOB:
V Original Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM /TYPE OF BUILDING
HEATING i/ RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING 56F, -FL,A,Ixs loF cS 0l j -FlLIS t-j/,T-0 ,J
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
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
STATE LICENSE-NO. NAME&TYPE SIGNATURE OF APPLI
PHONE NO. 6&0 ZI 3 ' 3 SS Z DATE q1 2- S