HomeMy WebLinkAbout100 Diane Drive (3)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Applica ' ere
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
L27-o
644-2511 ext. 230 0 73 N
Date 9ilding Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
1w DI'(0)e, 1D r yf2.
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT mg• S C,"ff,
APPLICANT ADDRESS /0C, Di g h 2,
f
APPLICANT PHONE# Ll 3- 93 iY
OWN 3 OWNER
q OWNER ADDRESS biAIler
O OWNER PHONE
C ESTIMATED COST$
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IS THIS A CONTRACT COST? Yes No
3
r
FEE ENCLOSED$
TYPE OF JOB:
40SOR.Cp Ne Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERM (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF UILDING:
HEATING RESIDENTIAL
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 OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT BTUH) I v0(,NET RATING(OUTPUT-BTUH)/S-(J U
TYPE OF FUEL
SIL-GPM OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
LR'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
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.
LaQ6wq*,t,
CONTRACTORS LICENSE N TYPE ST TE
SIGNATURE OF APPLICANT DATE
Shirley Wilhelm - CRS Approval Confirmation: Request No. 209726 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 7/23/02 9:50AM
Subject: CRS Approval Confirmation: Request No. 209726
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 209726
House No: 150
Lot No:
Street Name: DIANE DR
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Jul 23, 2002