HomeMy WebLinkAbout117 Bridlewood Road (4)DEPARTMENT DECISION APPLICATION FOR HVA PERMIT
TOWN OF SOUTH YM OR
PERMIT#
Application is hereby: 1 r-7 1 gBUILDINGDEPARTMENTAPPROVED1540SLI"VAN AVENUE Bldg.Permit#
W-2511 ext. 230 F6 Cw
Date Building Inspector
plipation must beprofto of o ,eel
FEE SCHEDULE Location of Job'
YN-6,-4 0 5 "RM,A
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C n
APPLICANT ADDRESS 96
4
APPLICANT PHONE#
OWN S OWNER Aq:
q OWNER ADDRESS
nCOT
O OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No.
C FEE ENCLOSED$ /2O.0 0
TYPE OF JOB-
S OR-CG'' Wew Installation
Alteration/Addition/Repair
b
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF B LDING:
HEATING UMESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
2-gYDRONIC 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 HEATINq EQUIPMENT(INCLUDING M &MODEL NO.) /
r-
lo,
D ' e qyl
0/ , -
GROSS HEATING CAPACITY(INPUTBTUH) 12Z AZ NET RATING(OUTPUT—BTUH)
TYPE OF PUEL
OIL—GPM as OIL TANK LOCATION:3 INSIDE OUTSIDE CAPACITY .3.34 aZZoAj
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.
3 0 23 3,q al
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE
I
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