HomeMy WebLinkAbout114 Cornerstone DriveDEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT l
AP 1540 SULLIVAN AVENUE Bldg.Permit#f
n 644-2511 ext. 230 i
ate Building Inspector
Application must be printed or typed
F$0FEESCHEDULE
Location of Job:
1 `
1,000=$15.00
Te-nant
reet No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Designation Apt.No.
1
APPLICANT CA C
APPLICANT ADDRESS '3'A P,
S -- --kt ) -ri A a oc c T 0 N U-"lei
APPLICANT PHONE#
OWN S OWNER 2'C
4 OWNER ADDRESSa
OWNER PHONE
C D ESTIMATED COST$ s o U
IS THIS A CONTRACT COST? Yes No
t wv FEE ENCLOSED$ Y v
TYPE OF JOB:
SOR-CO New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (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) F(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUTBTUH) NET RATING(OUTPUT—BTUH)
TYPE OF FUEL
OIL--GPM 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 WORKlyv-,)e C->(A
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.
cI `) :1 S-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 6