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DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT 3
1540 SULLIVAN AVENUE Bldg.Permit#
Z G
644-2511 ext. 230
bad Building Inspector
Application must be printed or typed
FEE SCHEDULE Lo ati ofJob:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Xp:t.No.i
i
aa
APPLICANT
r
ICANTODRESS
b
1'
APPLICANT PHO #
OWN SF OWNER
OWNER ADDRE S
0 OWNER PHONE i
ESTIMATED COST$
IS THIS A CONTRACT COST? NZYes No
j FEE ENCLOSED$ (O
TYPE OF JOB:
dSOR.Co w Installation
Alteration/Addition/Repair
Revised 4/01//2002
A PLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF STEM: TYPE OF BUILDING:
HEATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
g4AM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
RONIC WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE, F DIFFERENCE F
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DE CRs BALL H G EQUIPMENT(INCLUDING MAKE&MODEL NO.)
v
GROSS HEATING CAPACITY(INPUT-BTUH)7—-00014ET RATING(OUTPUT-BTUH)
TYPE OF FUEL
34 IL-GPM OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
GAS-INPUT Q .PG 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
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 W
C4 ,4;
2a56-
CONTRACTORS LICE SE NO. TYP i ATE
SIGNATURE OF APPLICAN DATE