HomeMy WebLinkAbout116 Bramlebrae (7)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT g9'
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVEDL 1540 SULLIVAN AVENUE 9-5A-6,7
AI0 Q M/1 644-2511 ext. 230
Date J ding Inspector
Application must be printed or typed
Location ofjob
vn e-- 34
Street No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt.No.
Over $1,000
12.00 per$1,000 OWNER—U 41 Roranyfractionthereof
ADDRESS ?9 6- Ce*ete.-r S-t,
OWNERS PHONE# 4 #3 9
APPLICANT
0 N S F,q
ADDRESS. 0 1
ESTIMATED COST $ 7 9 q-T aQ
IS THIS A CONTRACT COST? v
lu YES NO
FEE ENCLOSED $ Co 0 0
OR-CO ME OF JOB:
Original Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING RESIDENTIAL
A/C Vol 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 0 0 0
DESIGN TEMP. OUTSIDEq,5 F INSIDE `jot F DIFFERENCE s1-3 F
TOTAL HEAT GAIN(BTUH) A
HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT (INCLUDING MAKE&MODEL NO.)
yo K conc e s r l' ,30 Svc
TONNAGE_ COOLING CAPACITY(BTUH) O O
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 e::Z-ktS-tg-tl n recL
LO rG1 T'`b Pir 9 s s cLu. u a lC
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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.
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303 49-70 S-- l
STATE LICENSE-NO. NAME&TYPE SIGNATURE APPLICANT
PHONE NO. Co q ci- G 1 DATE 1 d 13 _g k
x, TYPE COOLING HWING
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