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100 Valley View Drive
Application No. 4916 Permit No. 4656 TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. L hereby make application for a permit to (erect (l e-er e) a building according to the following detailed statement of the specifications and plans herewith submitted. (Draw a line through word "erect" or words "make alteration to" as the case may require.) All provisions of the Building By-Laws (Sections 2 to 32 inclusive) shall be complied with in the execu- tion of this work whether specified herein or not. South Windsor, Conn— . . ....y............ 19.... f' wShereG.._........... Address . . .. Location. . ..?C) 1..+.4'... Nearest cross street? .... . . r t. c .. je..e...Street No. ............. ........................... Lot No. ... ...'. ... . Owner of land is. ....... ....ltw. 4 ... ;. ?.. ...........Address 7 .... Owner of building is? .. ... ..................... ........."...................Address ... .......... ...''............. 4t Krchitectis? ... . .............. ...................................................... ......................Address ............................................................ Builderis? ...........................'.`............,,....................................................Address .......................w...............................................`..................... ........... y atr Dimensions of building? X =... Feet front? .—Feet rear? . .......... Feet deep? ..S. Extreme height to highest po t of roof? ................, .... `... No. of stories in height?.... t Pu of building is? No. of stores? .... ................ ..................................................... ................. f No. of rooms? How many families? ... ...................... . .. .. .._................................... le Ir Distance from street line is? .. ........... from building line is? ................6.................................................. ADDITIONS AND ALTERATIONS Give Brief Description) 1.........` ......f.a,...... ............... ENDORSED BY SANITARY OFFICER IN ACCORDANCE WITH TOWN OF Map No. . 4UTHWIND IZ DINANCE NO. b1 SA ITAP,Y OFFICER If of steel frame, what is exterior construction? What kind of columns used? ..................................... .. .....Size of columns used? What length of columns used? ... ...................... . . ....... .. .....How protected? ... .. ...................................................... ........... What kind of beams or girders? ................... .... . . ............ Size of beams or girders? .............. ... ........ ..................................... Longest span of beams or girders? . ...................................... These rest on? . .......... ................. ............................................................. Roofconstruction is? .......................................................................................Roof covering is? .... ..... .......................... .. ....... ......................... . The floors; are of ..................................... . .... ...... construction and are calculated to carry a safe load of lbs. per square foot. See Section 14, Building By-Laws.) BRICK CONSTRUCTION. Ofwhat material will walls be constructed? .. ......... ....... ...................... .................................................... ............... ........ .... ............. Compositionof mortar? ..................... ................................................................................................................ .......................................... ................................. Height and Thickness of Walls Reftht stories Front Walls Side Walls Bear Walls Partition Walls Basement, I.................................... ........................................................................................................................................ 1st Story 2nd " I....................................................... ............. 3rd " I............................................... .......................................... ...... 4th Is I..................................................................................................................................................................................................................... 5th 'd 6th 96 7th so I.................. ...... ......................................................................................................................... 8th 88 I......................... ............... .. ......................... ................... ................................................... 9th dd I .............................................................................. 10th Material.of Front? . . .... ... If stone, what kind? Thickness of Ashlar? .. . . . ......... ...... ..... ........ ......Thickness of Backing? Backed up with what? Arches or lintels over openings? WOOD CONSTRUCTION. Give Size, Longest Span and Distance Between Centres, of Joists, Girders and Columns JOISTS GI$DMS OOLU MS Floors I alas Longest spin Centres E Bite Longest span Centres she Length Centimes lst Floor f........... ''//'....... t ................ t, _i' .._...../......f..._.. j. .._! ....._..._....... 2nd " 4 ... .... ................... .................................. ................... ...................... ............ .............................._. ......_..... _..._._.. ...__.._.. _................ Size of outside studs? ....' Distance on centres? ........... .... .................. Size of sill? .........r,,X...., ............ Size of rafters? ....X......(P......... Distance on centres?..................... Size of plate? .......... -... Size of ledgers or girls? ............................... .............................................Size of deck rafters? .................................................................... ............... Distance on centres? ........................................................................................Size of studs in bearing partitions? ............. ..X../......... MISCELLA EOUS Style of roof, flat,.pitch, Mansard, or hipped .............. , ..:....................... Fireplaces? ........ :,................... f f covering? . ..... .... Cornice? .........:........... .....-.ems.... .Material o roof Material of Corn e How is building heated. .. ..............7...A:.... ... ...... .........Lining of flues. .. ................... ..... .... ..................................................... f Thickness of shell of flues? .................... ..... .......................................Any elevators or lifts? ................................. ...................... ..... What kind? .................................................. How many? ................. . ... ......................... Any hoistways? How protected? . ............ ....................................................re"Total Value of Building .......... ... y.. ... .... ............... I 1 ,,, r.. ...5;..C C. .......,.When will work be commenced? ...... ...... Z. 4 -AI ..............rt.li....... c The applicant warrants that the lot for residential purposes, shown on a plot plan accompanying this application, conforms to the zoning regulations of the Town of South Windsor. ApplicaoleL--:4- 4656 BUILDING APPLICATION Application No. ...4.91.6........................................................ South onthe ................................................................................ Side of Valley.. View Drive .. Street.Valley Lot #62StreetNo, Owner U R...HOUS-Lag....Carp*......... Applicant . Same . ... .. .... CLASSIFICATION Dwelling 581X24.1 ...... ............. ........ ....... Permit issued on above Application. Date, .ll!-!29-63 ......... 19 .. . .. TOWN OF SOUTH WINDSOR BUILDING PERMIT Date IIo9'29' 19 63 Fee Paid 72'00 Est. Value $. . 180000 9 l F'_`..y . w g ye'9-+_ }y` ..+, f ..oG.i•+i•o.ars.sssgB Permit NO 4656 on the South side of Valley View Drive Street Street No. Lot #62 Owner U ji R Housing Corp. R Applicant Sale f CERTIFICATE OF OCCUPANCY ISSUED: s 6 Date No. Fee Paid $ 3.00 CLASSIFICATION Dwelling 28IX241 BUILDING PERMIT N? 4656 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. f• 19 T4io to to Tjvrt'tfq,A That f is hereby granted permission to at estimated value of '$ on the ' t r side of e-Street on land owned by a C z Said "'r"` to be as described in Application No. and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued 19 Building Inspector. Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." I I I Permit No. TOWN OF SOUTH WINDSOR SOUTH WINDSOR, CONN permit N° 2741 I 1 Cert' ' to of Occupancy oze I THIS IS TO C TIFY t the 7 at No. in the T of South Windsor, Connecticut, has jbeen erected and ' pleted in accordance with the B ding Code and Zoning Regulations of the Town of South Windsor, and is hereby approved for cy. I BdiWng r'r a i I Owner, Iguilder Fee Paid Date I8 43 I ILDING Q R s t u o. o G 3 i 1 C ON V g 536 VPILLCY Vlrz--O D ;2 qe riiirrni nrtttt1tl 1Ia11 ar PROPERTY OF NO . VALLEY VIEW nR IVE SOUTH WINDSOR, CONK . Being Lot No. 62 on map entitled "Map of VALLEY VIEW FARMS Ellington Road South Windsor, Conn . Property of Emma Palmer & Kenneth Palmer Scale 1 " = 80 ' Nov . 1 , 1960 Hayden L. Griswold Scale I " = 50 ' HAYDi;N L. GRISWOLD GA. 2895 1 r PLUMBING APPLICATION 2684 Application Nun on the ....SOuth side of I galley View Drive sum 3 Street No.Lot #62 Owner ....._U & R Housing Corp. plumber ..JS Guastamachio Filed in Offim of The Bak6g bopector 1.10-64 19 No person AA cmsaui, add 0 or alter OW portion of the drainage Wo m of any bwl&w cw" to repair lea.6) until a Permit is graouaod by the Building h apemw. f 2684 2895 Application No. .. ................................ Permit No. . . .......................... TO THE BUILDING INSPECTOR r of the TOWN OF SOUTH WINDSOR. CONN. hereby make application to perform plumbing according to detailed description below. All provisions of the Rules for Sanitation, By-Laws, Sections 33 to 47 inclusive, shall be complied with whether specified herein or mt. South Windsor, a.", (o........... ... .... ... .. 19 69/ Sign here - Address I....... Location 14 side of Street Nature of Building How many stories Owner .. ... Mc.R C. ........ . . .Address - q5-Z-5-7 WaNy.....ku"ek Architect ................................... .. ...................... .......................................... Address ... .......... ......... ........................... ... ... .............I...........I........ Builder ............... ................ ............................. Address . ................. ........ ........................................I ................................ A' Z"'---"-'-*...*... x4CPlumberAddress DRAINAGE CESSPOOLS, How many 1. .... ...... Where located . ...... Are they water tight Of what materials are they built ...... Size of pipe from house to 4-.';esspool Kind of pipe ..........C ...... .. ............... . ................... ..... MAIN DRAIN IN CELLAR, Material a. 77 Diameter . ...../. .. . ........................ ... .. .. ... ............. .. ... Aboveor below cellar bottom I........................................................................... . ................... SOIL PIPES Material . I... ... .. .......... Diameter ..... .... ................. ... .. ....... WASTE PIPES, Material Diameter TRAPS, Type proposed to use is RAIN WATER LEADERS, where do they run to REFRIGERATOR WASTES, where do they run to I........... TANK OVERFLOWS, where do they run to I..............................I................ FIXTURES WATER CLOSETS, How many ......Q. . ......... ... .. Where located Distance from trap to vertical soil pipe ............... .............. Pattern WASH TRAYS, How many .. . .. ................................. Where located SINKS, How many I................... . Where located .... ........ ... ................................................. . BUTLER'S SINKS, How many ......... ............................ Where located .. ........ .... . ........... ........................................... REFRIGERATOR SINKS, How many . . .............................. Where located . . .................. ................ . ........................ LAVATORIES, How many --TQ-...'I—,...1-1-1*1*11*11111111-,.......*........ Where located . . ............................................................................... BATHTUBS, How many ..................................................... Where located . . ............................................. ... .................... .. Howmany ....... .... ............. ................ ........ Where located Are water closets and urinals to be local vented If not, is there a window in outer wall of room where same are to be located Estimated Cost ........Y-e).4....................... 1781 OIL BURNER OR FUEL STORAGE APPLICATION Application No. Permit No. 1781 on the South side of Valley View Drive Street Street No. Lot 62 Owner U & R Housing Corp. Application D.F.Tr ame nt a na CLASSIFICATION AmPries.n Std - PH5-2 Permit Issued on Above Application Date 1-22-64. 19 Fee Paid $ Permit ##4656 TOWN OF SOUTH WINDSOR APPLICATION TO INSTALL RANGE AND FUEL OIL BURNERS EQUIPMENT AND TANKS PERMIT N 1781 DATE Z/77 lie- 4" The undersigned hereby applies for a permit for the installation of range and fuel oil burners, equipment and tanks of the following description: Address 1st floor 2nd floor _ 3rd floor Character of Building: Frame Brick Owner of Burner Owner of Building Lessee or Tenant RANGE BURNERS Capacity of Tank at Range in cellar outside—_ Name of Range Burner Purchased from POWER BURNERS Name of Fuel Oil Burner _ S Z Model Number _ Purchased from Name of Tanker Gauge of Tank Z Where is Tank Located Size of Tank Size of Motor Size of Wire Will other heating equipment be installed? --_ If so, by whom L, , -0- d cz/7 Name of Party Making Installation Address n6 e -A Electrician Address Signed DAPPLICANT All provisions of Ordinances of this Town Regulating Oil Burner Equipment and Fuel Storage (Sections 1-23 in- clusive) and Underwriters' Code applicable to the subject matter of same shall be complied with in execution of this work whether specified herein, or not. Estimated Cost $— Application for Permit received 1-11-64 and Permit No. 1781 issued 1 22 64 Permit Fee Paid _Permit_ #4656 Approv _ r 1 BUILDING INSPECTOR t PERMIT # Application For 6393 5292 DEPARTMENT DECISION Heating Permit O 3 APPLICATION IS HEREBY: 11-4 DEPARTMENT OF LICENSES AND INSPECTIONS N IN APPROVED C1 DISAPPROVED r TOWN OF SOUTH WINDSOR 3/3/81 Z11t;,O 0) DATE CHIEF INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL W O 4 to rz -0 1. LOCATION OF JOB O w o v NO. STREET O LOT NO. FLOOR APT. N O N 1Oi 2. OWNER /Q'1. TT/L,L C nit0O O s. ADDRESS 1,k E f bo 3 4.PHONE Cc C0 S. APPLICANT W I SOP o_ to s. ADDRESS . T aid 7.PHONEstir 6. LICENSE NO. Q O w S. EXPIRATION DATE OF LICENSE 10. ESTIMATED COST : 7/1),e6 O 4J •C 1 t. IS THIS A CONTRACT COST? YES NorzbeJ ,fin 12. FEE ENCLOSED i v e. k 12. TYPE OF BUILDING:a 1Z RESIDENTIAL COMMERCIAL y 14. TYPE OF JOB: INDUSTRIAL Cd 3 RIGINAL ply ALTERATION INSTALLATI N Imo. ADDITION REPAIR APPLICATION FOR HEATING PERMIT (Continued from Reverse Side) 11. LOCATION OF JOB Al z' NO. STREET FLOOR AFT.NO. 12. TYPE OF INSTALLATION: OIL BURNER ELECTRIC VENTILATION SPRINKLER GAS BURNER STACK INCINERATOR MISCELLANEOUS SIZE IDENTIFY / SIZE 13. OF TANK LOCATION SIZE t3 OF VENT / /OF TANK OF FILL ta. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE BOILER OR FURNACE MAKE AND NQ:T&MZdytA4*T.U. OR SQ. FT. NET B.T.U. OR SQ. FT. GROSS FIRING RATE FLOORS TO BE HEATED NEW OR OLD BUILDING INSULATED - YES OR NO TYPE OF WALL INSULATION ROOF OR CEILING INSULATION AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION INDOOR-OUTDOOR TEMPERATURE DIFFERENCE FAHRENHEIT MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS. OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ. FT. OR B.T.U. DESCRIPTION OF WORK Z c/,iZ d AGO E-G da /Ic TAG°"/chit5. TO BE DONE; T/¢'' -.? •y 16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS): R OM SIZE WIN Dows AREA - SQUARE FEET a,T.U. a.T.U. AND DOORS VOLUME F DISTRIBUTION INSTALLED TOTAL TOTALNO.ROOM L w N AND W GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED t j t RAD. RE ISTER SIZE WALL GSO INFILT.) TEMP. TO • F F:ci TYPE AND SIZE $ 0. FT. OR LEADER DIFF. F F m h FREE AR EA 75< TOTALS A. HEAT LOSS FROM BUILDING B.T.U./HR. B. DOMESTIC HOT WATER DEMAND B.T.U./HR. C. PIPING. OTHER THAN NORMAL B.T.U./HR. ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR 17. ELECTRICAL WORK BY; NAME ADDRESS SUBCONTRACTORS AND 1a. THEIR TRADES ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE(OWNER) OR (AGENT) OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE. APPLICATION TO BE COMPLETELY FILLED IN. Al-AN 4DATEtJ 81GNATUR9 F APPLICANT`/ FINAL Building SPEC s: APPLICATION FOR BUILDING PERMIT Plumbi HVAC Date: —a — Sprinkler 100 VALLEY VIEW DRIVE Electric Estimated Cost $ tSso Zoning Permit Fee$ 20 Affidavit NO. 22124 Occupancy Fee $ Eng. Dept. Fire Dept.COMPLETE RED BOXED AREAS.Total Fee $ Health D Pt. TYPE OR PRINT ONLY Approved for CO: SIGN ON REVERSE SIDE. Additional Cost) $ TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT The and rsigned, hereby applies to do work according to the following specifications: Job Locatio kuj Ur Lot No. Side of Street Zone Applicant 0. `qk '-eC_c Tel. # ; Z Address — W f:l e, Zip 6(.1 OFF Lic.# 5 1 3 Q"7 7 qdE CITY STATE Owner ddress/D0 yQ 11.e V V"ev%J Dr Architect Q vy 5 Agf/CQµAddress Size New Area: Ft. Front Overall 20 Ft. Deep Overall : r Total Area ti`0 Garages Lavatories Size of Lot Dist. from trleet Line Bathrooms Roo s 1st 2nd 3rd Purpose of this Permit 1 6V + c C06 r rq,w ;` 7--<2cp City Water Well 0 Septic 0 Sewer $0 Use Group Construction Type N Approved by Date Z II7 K - BD1A 11/88 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinanc s of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines and required distances from all other zones and is located in a zone in which this building and its use is allowed. Signed—co j. ,4' a 1 hereby apply for a Certificate of Occupancy for the work described in this application for permit. Signed DO NOT WRITE BELOW THIS LINE— INSPECTION RECORD Footing Framing Foundation Fireplace/Chimney Insulation Plumbing Permit# Inspections: HVAC Permit# Inspections: Electrical Permit# Inspections: Sprinkler Permit# Inspections: Inspection / Approval Date By Appl Code Description Due Whom Code Comment 95-22124-B 1 , 550 BO1 FOOTING 03/08/95 JFH A B10 FINAL 03/15/95 J F H A Total Est Value 1 , 550 RBU p1N, Loo, ov 16 63 y ; t tit, i , t, - r "9 :,. r x •. . elA', f. .,,r` t,. 'tip - i' •^ 'r 1 ^' 51l.\Q Pl•nT'•'7`••) , . I R r 'H aa{y; r 1 5., .`d'+ :i- lr'F.J]!y r ^'+ t' ° !)•;a y'''(`M v J aL°#4) s 1,, 1``• '{ }''. Pf,;`' pa '.4" i n c•lu^G .L r`•g„y' kr :,J':r" . 1, t, I• sPsr,lo.r •M"'`'; ''-•tv,e :. + - r r,ti i• •, !. _ + k'• i•° .,.. , ,S, .. :..•1 y,a.w P ' •v' kr-f' 'a.'% `I'',w'•'. -•. i. fiY:'r. s t r R. _<A, s,,- n yMr• c i -'•.r.•;+,Yi{'.i4Y't d,,. -, J •Y' e t' S d do W)i• tY Hd ' rar • P 4 Pmo vkxh• ^w „`;;' ,• - ^btv.` c•\- , ee r •'~ :xe t1"y:•,i'.. 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'1,I ,,kN`rej ` vT d :i vs, t• r"a+. 3t FtrrGY .i,,, ".,x; ."ri'G-' . @ d•F'' 'j x ''?`•r fL rl..J 1'l''t~ .ir;'q f p,1. i.. !'*.-.T,t t. •",1C },' :,.n 4^ v y'•j,'A' k.0 i !, •do ''•' y,a,,,., •'bo. ,.i t`'A M." e n,it^ .0 ..La,. »P Sw '0>'rU?'4t, ;.•+[S°,'},#,p. •ti.;it_'l d„a: w r. •YE" 1 up'TLtkt ,^• r J,:.'y, ,r'-ej.r ,%r s, { 4.','p'°. iii;r '••' e y, 1'.;' ,,; e•"fit+ r•`' Ask• r r,n'. r' y, f,!'", `Ihl,'"* ':• I .i, wx i, •.! t Y• ,/t, e t.e ,: ALL VII;i(r FAR " . 1 lingt a r g x n P . e ,1.t. p1`.•'`,j '! 1"'= ram. ,R,:r i,• ` ' ,' , f,'r, t 2,u° v°, .tr;A. ! r ti .. 7.1 '• Y' 1h.•'i N l:r<. ''+ ,h•7"I !•}, 1: tirr. jF t'{'m•}a '1 i ' C x'J^' ri t^'igl , ' ,r `? S'_'Y4 i,;, f^, fi •4';r. Y',:a' h: .,,• ' r, d• t y t, „rF' r, v`;., x•, ©ada ottt '°' cso Conn• P opQtr o Baats 'Palmer .&. I @nmeth Pa1me M,r 1'L i.," hT.1 ay rat 1• r y.. yita f . r r 1•• r yr S _ r e d,j u. :Y f 4:. ^.*'r;!"'P'•:r t, y ,, t, i is `r_ .`., .i',•4' t j' ' . 01, 1, 1960 Hayden L. Griswold G •, e`.' x t ^„, •,. . 14. R A) I , r era F .,'J 16 r ,a,,•q ! T• W r yr , f J 1 A r' '^r Y,.r'. j,. HAYDEN L. GAISWOLD C*I*-.. All, t• t oaf.: - , 1• ` v• t}' iC R • +- r r«V` c mil A. ,,K .,t.i r'' x ` o r t,dtr 1 t'j Y g'it fir, Y r. ', :. ... t u• 1, 1... .i.,--r-->--^^."•.r.rr-,ter'........,..P// •`, ti l d: +lid- ',e. i'v p• IV II.E yT TOWN This Certi'ied ttl,•t lY,t rlin and sro'crrlr. ,;,tit.copies of the proposed building or altcra ,,,.,s to b,erected at Strtc• t gcther with amendme,te, st.;t d onttlA .vlth of n acd I ,11?r.e to cnr-•1 ,;ly wthr,,ti,r F,"1.1i.-1,Fnd st.•t. 1:,vs a,;d S:••h or(!:•; F silt d by the P.,;tdl iq r)ra,rtm_ni rrl^K prnacl:1' grit ®PPCCation and tonal issuance of a bul;dln;,permrt. Signtd IN% plan Is IPproved subject to the conditi—on thatoM`fs ar^d ordinances regulating building shall beCami,tiod wtth, COftdltI0n-aIly Approved These filed with CIGI li ate Z, 2/ aMo: DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERNUT 44Y'7qs Application is hereby: TOWN of SOUTH WINDSOR BUILDING DEPARTMENT Bldg Pe # APPROVED 1540 SULLIVAN AVENUE 644-2511 ext. 230 Date lding Inspector Application must be printed or typed Location ofjob di 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 ADDRESS OWNERS PHONE# APPLICANT OW N st ADDRESS. ESTIMATED COST 0 IS THIS A CONTRACT COST? YES NO FEE ENCLOSED $ c Z TYPE OF JOB:OR Original Installation T::7 Alteration Addition Repair Revised 11/95 APPLICATION FOR HVAC PERMIT(Continued from reverse side) TYPE OF SYSTEM TYPE OF BUILDING 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 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 DES PTION 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 GNATURE OF APPLICANT PHONE NO. fC/5 DATE e- I'NSPZCTOR DAB 0 TIME LOCATION too ,4 11-- , _. INSPECTION: CODE: RESULT(D/A) : BUILDING: ELECTRICAL: PLUMBING: HVAC: OTHER: