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HomeMy WebLinkAbout12 LakewoodJEtrTo V X iv TO THE BUILDING INSPECTOR Of the APPLICATION FOR PLAN EXAMINATION ANDTO" OF sovzx w nsott, cor rr. BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, I1, 111, 1V, and IX.o ZONING AT (LOCATION) d DISTRICT LOCATION NO.) ISTRE T) OF BETWEEN ,W ffllT. AYI Ili.n t L-O.P(.(/AAcI AND BUILDING V CROSS STREET) GROSS STREET) LOT SUBDIVISION Li-10 uj'I'd LOT BLOCK SIZE N 11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D v A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn 1 1ew building Residential Nonresidential 2 Addition(if residential, enter number 12 One family 18 Amusement, recreational I o/ new housing units added, i/any, in Part D, 13) 13 Two or more family - Enter 19 Church, other religious number o/units- -- - - --0- 20 Industrial3 Alteration (See 2 above) 14 Transient hotel, motel, 21 Parking garage4 Repair, replacement or dormitory - Enter number 5 El Wrecking (1/multifamily residential, of units ------- - - 22 Service station, repair garage enter number of units in building in 15 Garage 23 Hospital, institutional Part D. 13) 16 Carport 24 Office, bank, professional 6 Moving (relocation) 7 Foundation only 17 Other - Speci/y 25 Public utility 26 School, library, other @ducat; nel B. OWNERSHIP 27 Stores, mercantile 8 E Private (individual, corporation, 28 Tanks, towers nonprofit institution, etc.) 29 Other - Specify 9 Public (Federal, State, or local government) C. COST Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food processing plant, machine shop, laundry building at hospital,elementary 10. Cost of improvement,,,,,,•,,,,,,,,, school, secondary school, college, parochial school, perking garage for. department store, rental office building, office building of industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical...................... py, Q lZe b, Plumbing ......................J tc,, e. Heating, air conditioning......... d. Other(elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part 1, for all others skip to 1V. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30 Masonry(wall bearing) 40 Public or private company 48• Number of stories................ 31 'Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area, all floors, based on exterior 32 Structural steel dimensions .................... 33 Reinforced concrete H. TYPE OF WATER SUPPLY 42 ublic or private company Total land area, sq. ft. ........... -34 Other - Specify P 43 Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed .......................r F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 35 Gos Will there be central air 52. Outdoors........................ / 36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 Yes 45 L. oo 53. Number of bedrooms.............. 38 Coal 39 Other- Specify Will there be an elevator? 54. Number of Full.......... 46 Yes 47 Q'No bathrooms Pertiel....... IV. IDENTIFICATION — To be comp/et d by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. I. Owner or Lessee 2. Contractor 3. Architect or Engineer The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. Signature applicant Add*ss Application date 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans By Date Plans By NotesFeeStartedApproved BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Date Obtained Number By Permit or Approval Check ObtDained Number By BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS 01L BURNER WRECKING OTHER OTHER VII. VALIDATION Building Permit number Bui Iding Permit issued l 19 Bui Idingv0 Permit Fee $ G' Approved a t TITLE TOWN OF SOUTH WINDSOR BUILDING PERMIT Date- May 13 ig 86 Fee Paid $. . 3.24 .0 0 Eat. Value $. 5.4.r.0 0 0 Permit N© 15078 on the aide of Mallard Place Sava Street No. 6 Owner RSK K _1 1 no Tn __ Applicant Carol S_ K P 1 1 P V CERTIFICATE OF OCCUPANCY ISSUED: Date No. 7 6 13-- Fee Paid $ 1._p.o _ CLASSIFICATION Dwelling BUnDj NG PERMiT M 150'78 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. may 13 1986 94is is to Certifg, That Rax-Kelico inc. is hereby granted ion toP at estimated value of $i on the side of Street on land MIMMM.M;Iard Place owned by RK-Ke1]co Sao Said Work 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 1986 lam 4 1f 1 3'r!f!' Building Inspector. Streets and sidewalks, obstructed by ezcavations 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 plaea 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." DWeiling - Lot 6 i LKWD 5/13/86 RSK-Ke l lco Inc. Jfe Mallard Place J2' Permit #15078 Electrician Michael Finnegan #9472 Heating Contr. Mellen Energy 6473 / plumbing it Mellen Energy 7042 Oil Burner Certificate of Occupancy 7613 Sewer Permit plot plan apprd. per Eng. i Permit No. ,E TOWN OF SOUTH WINDSOR SOUTH WINDSOR, CONN. I i I Permit 1\O 7613 Certificate of Occupancy i r i THIS IS O CFPATIFY)hat be at No. in the wn of South Windsor, Connecticut, has been erected and completed in accordance with the lding Code and Zoning Regulations of i the Town of South Windsor, and is hereby approved for occupancy. Building Inspector wner, Builddir i Fee Paid Date 19 9472 ELECTRICAL APPLICATION Application No. 10985 on the Side of I•allard Place Stmt Street No. 6 Owner RSK KellcoInc . Electrician Michael Finned4an FILED IN OFFICE OF The Building Inspector Dec . 1 INBPI=WN. w No Electrical Work shall be started until a Per- mit is granted by the Building Inspector. In New Buildings no wiring shall be started until the plumbing and heating pipes. and-the Are stops (if of wood) are installed, without a special permit from the oAlce of the Building Inspector. Electrical Permit No. .....[.1_.1 Master License License No./[R.ZZ. ...--_- TOWN OF SOUTH WINDSOR Building Permit No. .,l 5 ..Y.._.... BUILDING DEPARTMENT Date Filed ..`,. .. __..........__.... Date Final Approval ..........................._.........__..... APPLICATION FOR ELECTRICAL WORK Electrical Inspector JOB LOCATION: C.. ....... ....(`-1 f7 t dZ7._ w.. JOB OWNER: .............. ..... _........................ Side of ...................................... Between ............ jj .................................................................... and ..............................._......_....._. Name of Building Owner ...... .... 1.CA.ti 3..:k...Address ................... .. G." 1ZY . If work is for Lessee—Give name Address ...._._.... ......................................................................... Building now occupied as (unles new) No. of family units now ........... ....._..........s., .................... Building to be occupied as ..... A .......................... Number of family units to be Is this work included in a Build* Permit? ....... ............. ...... Permit Fee ..........................................................._............_............................__.............. If no Building Permit) p Permittee `.. ; ness Address ..71.....rL Telephone .... `..........._ J"7- COST OF INSTALLATION: fw 1, ..._ TO BE FILLED OUT BY PERMITTEE TO BE WIRED EXISTING APPLIANCES Number of light outlets to be installed . . ....._.........._........... Number of convenience outlets to be installed ............................. Number of present Appliance Circuits ................................__... Number of switches to be installed . . . ..............- -• Do these include Range Water Heater Number of appliances to be installed . . . ...._............_....._ as listed below) Dryer Air Conditioner Oil Burner TYPE RATING NO. Dish Washer Gas Burner Range . . . • • • • • Well Pump Elec. Heaters Range Top . . . . . . Oven . . . . . . . .REMARKS: Water Heater Clothes Washer Clothes Dryer . . . . . Dish Washer . . . . . . T 7 Air Conditioning Motor . Oil Burner Motor . . . . Gas Burner . . . . . . . Circulator Motor . . . . Attic or Large Fan Well Pump . . . . . . Electric Heat . . . . . Other . . . . . . . . Number of new Lighting Circuits Number of new Appliance Circuits w... Number of Heating Circuits Number of Motor Circuits . . . . . . . Size of present service ..._.......................... ..........._._..._____.. Size of service to be ........._......_........_.......__ ._ 7042 PLUMBING APPLICATION Application No. 6.81.3 on the ... ....._ side of e L C P..b ce Sceeet Street No. _._ A lC-- Owner Plumber Filed in Office of The Building I rpeotor June 2 7 ig 8 6 No person:hall coastinut, add 0 or abet ash portion of the drainage system of any boMfing except to repair lealm) until a Pits wood by the Building Lapeaw. APPLICATION FOR PLUMBING PERMIT (Continu d from R verse Side) TOWN OF SOUTH WINDSOR, CONN. 11. LOCATION OF JOB 1 2 C' // ,TRZ Q e b p/C / FLOOR APT.NO. GENERAL PLUMBING 12. KIND OF INSTALLATION 13. SIZE OF MAIN DRAIN d , 14. NO. OF TOILETS STYLE cI 15. NO. OF URINALS _STYLE 16. NO.OF BATHTUBS 17.NO.OF LAVATORIES -:2, 18. NO.OF SINKS f 19. NO. OF WASHTUBS 20. NO.OF CONDUCTORS tP9_SIZE 21. NO. OF STACKS SIZE ? r. 22. AREA OF ROOF 23.NO. OF CATCH BASINS "' 24. NO. OF FLOOR DRAINS 25. NO. OF OTHER FIXTURES KIND 26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW?27. SIZE OF WINDOW'` Q Y ^ 28. IF NO WINDOW, WHAT KIND OF VENTILATION IS THERE? 29. SIZE OF DUCTS ... 30. ARE SEWAGE AND WATER FACILITIES AVAILABLE? SIGNATURE ADDRESS/0 c:;2d.3 LICENSE NO. ESTIMATED COST 3 3>G', TELEPHONES-ode OWNER / r l1 ADDRESS WATER HEATER 31. TYPE Q' 32. MANUFACTURER t/ TANK SAFETY DEVICES 33. CAPACITY 0 37. TEMPERATURE RELIEF VALVE 34. TEST PRESSURE_ cry 38. MANUFACTURER 35. WORKING PRESSURE / y 39. PRESSURE RELIEF VALVE 36. TYPE t' 40. MANUFACTURER zl14a2.,J ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE. al_z t-- R-(- I - (,0 CD962 DA IGN TURE OF APPLICANT PERMIT Application For 6273 6 4 74tr DEPARTMENT DECISION Heatmg Permit Co MO c APPLICATION IS HEREBY: DEPARTMENT OF LICENSES AND INSPECTIONS 1 LT-APPROVED DISAPPROVED TOWN OF SOUTH WINDSOR 0 a 6/27/86 Thmas P. D' Auria 00 0) DATE CHIEF INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER NE BELOW O r>7 E 1. LOCATION OF JOB QO C M0. STREET 4 v LOT NO. FLOOR AFT. NO. 4 E s. OWNER a - M&5 0 a o s. ADDRESS eo $ s.PHONE 0o a S. APPLICANT V. 0 s. ADDRESS 162 . uilw 7.PHONE g LICENSE NO. 77yalL Q o s. EXPIRATION DATE OF LICENSE v 10. ESTIMATED COST 1. Is THIS A CONTRACT COSTI eo YES No 1:. FEE ENCLOSED Pe mpit 15078s 0 is. TYPE OF BUILDING: Q RESIIEMTIAL COMMERCIAL O C 14. TYPE OF JOB: INDUSTRIALcc3 b INSTALLATION ADDITIION REPAIR APPLICATION FOR HEATING PERMIT (C ntinu d it m Rev roe Side) 11. LOCATION OF JOB L o 7- # p D r_/&c E'er NO. STREET FLOOR APT.NO. 12. TYPE OF INSTALLATION: OIL BURNER ELECTRIC VENTILATION SPRINKLER GAS BURNER STACK INCINERATOR MISCELLANEOUS IDENTIFY SIZE LOCATION SIZE SIZE 13. OF TANK OF TANK OF FILL OF VENT 14. B.T.U. EQUIP. AT REGISTER 1RNtCj_' MULJCE AND NO. AT BONNET FIRING RATE BOILER OR FURNACE MAKE AND NO. - r 0 B.T.U. OR SQ. FT. NET 22 M_B.T.U. OR SO. FT. GROSS FIRING RATE FLOORS TO BE HEATED NEW OR OLD BUILDING NSULATED — YES OR NO I ' INSULATIONTYPEOFWALLINSULATIONROOFORCEILING 1r. 17 AVG. SYSTEM WA ER TEMP. 4r{ &INIT.U./SQ.FT./HR. EMISSION INDOOR-OUTDOOR TEMPERATURE DIFFERENCE FAHRENHEIT MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS. OR C.I. RADIATION. OUTPUT PER qWTION OR LINEAL OF RADIATION. SQ. FT. OR B.T.U. DESCRIPTION OF WORK r. r"`""" t6. TO BE DOME: r vi :. '''- • t .r 16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS): Room slzE wlNoows AREA - SQUARE FEET IS.T.U. E.T.U.DISTRIBUTION INSTALLEDAMODOORSVOLUMETOTALTOTAL ROOM NO.OROSS CLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED J j LL A REGISTER L W N AND ` TEMr. TO TYPE AND SIZE MAD. OR LEADER SIZE < WALL .'ctG INFILT.) OIFF. F 0 an so. FT. FREE AREA Al TOTALS A. HEAT LOSS FROM BUILDING B.T.U./HR. B. DOMESTIC HOT WATER DEMAND 2 7 '_IL B.T.U./HR. C. PIPING. OTHER THAN NORMAL B.T.U./HR. ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR 7 5 cr 17. ELECTRICAL WORK 8Y: NAME ADDRESS SUBCONTRACTORS AND te. 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. Jt DATE 6F •991 leAUT I - B- JRCULATIONSHEET1503 (Modern Method) Copyright 1977 by The Hydronics Institut OWNER ??Z r GenTewc-`oes a ADDRESS b%1&Ujr3OL ~ %y'eieTa-A DESIGN TEMPERATURE DIFFERENCE LaF. DATE ' COL.A COL.B COL.C COL.D COL.E COL.F C L.G 1 'ROOM Ir. i !- w ( L, Lit v A a TH y O H L W H L W H L W H L W H L W Design Water Temp. 2 ROOM DIMENSIONS,FT. Z J l /2, BTUH per F t f 3 LENGTH EXPOSED WALLS, FT. Q 3,6 1313 d3 Radiation Selected 4 WINDOW AND OUTSIDE DOOR AREA a 6 BTUH BTUH BTUH BTUH BTUH 5 WALL CONSTRUCTION Oct Dd I (yOO O 60 Q d ROOM LIN.FT. FTable9,Line 3 x H)G TOTALS RADIATION 6 TYPE OF GLASS FROM LINE 12 SELECTED B ttom f tabl used for Line 5) 1100 91 CTO Q 1 .9040 Q O O 3 co 0 7 1 CEILING CONSTRUCTION I Ion Table 9,L x W) Q 1 20 O O 42040c A O O C B FLOOR CONSTRUCTIONt D Table 9,L x W or Lin. Ft.) E 9 COLD PARTITION CONSTRUCTION F 2966 Table 9,L x H) V?,",eJ6 10 c 1 Wall(With Openings) 70 G 2 Walls(With Openings) o e X v/ J O O 3 0 b 0 0 H r d O ,J3Walls(With Openings)or Ent.Hall I 11 TOTAL BTUH AT 70F TEMP.DIFFERENCE' Q Q b C, .... O 6 Z 12 TOTAL BTUH AT DESIGN TEMP. DIFFERENCE JR 0 O 5-o K 1 L 3qdCOL.A COL.B COL.H COL. I o COL.J COL.K COL.L TOTAL BTUH TOTAL 1 ROOM Q ICn y 3 C T' y OF BUILDING RADIATION AT SELECTED O H L W H I L W H L W H L' W H L W DESIGN TEMP.- 2 ROOM DIMENSIONS,FT. 2 U L{ 19T DIFFERENCE 63LENGTHEXPOSEDWALLS,FT. Q 3 4 WINDOW AND OUTSIDE DOOR AREA Cj BTUH BTUH BTUH BTUH BTUH 5 WALL CONSTRUCTION INCREASE BATHROOM Table 9,Lin 3 x H) 900 0?v2 O 40 3&0 TOTAL 20% 6 TYPE OF GLASS 8 ttom of table used for Line 5) 9 Q Q l 7 CEILING CONSTRUCTION tFOR CONCRETE FLOOR ON GROUND LEVEL. O` EL.USE LINEAR R FILL ATL(Table 9, x W) QVO v O g FLOOR CONSTRUCTIONt R= 7" FEET OF EXPOSED EDGE Table 9,L x W r Lin.FL) 9 COLD PARTITION CONSTRUCTION Table 9,L x H) j r, 10 ,c 1 Wall(With Op nings) V n d 2 Walls(With Op nings)T 5 •Xa2 09D O 3 Walls(With Openings) r Ent.Hal! t I 11 TOTAL BTUH AT 70F TEMP.DIFFERENCE' O O 12 TOTAL BTUH AT DESIGN TEMP.,DIFFERENCE This f rm is available from Th Hydronics Institute,35 Russo Plsce,Berkeley Heights,N,J.02922 ...''`. . 1 , ......, FORM 1503 FINAL INSP 1 Building APPLICATION FOR BUILDING PERMIT Plumbing VAnkler 12 LAKEWOOD DRIVE Date: Sprinkler El ctric 14allard Place) Estimated Cost $ nTV Zoning Permit Fee$ Affidavit NO. 18148 Occupancy Fee $ Eng. Dept. COMPLETE RED BOXED AREAS.Fire Dept. Total Fee $ Health Dept. TYPE OR PRINT ONLY Approved for CO: SIGN ON REVERSE SIDE.Additional Cost) $ TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT The undersigned, hereby applies to do work according to the following specifications: Job Location 12 Lakewood Dri vP Lot No. Side of Street Zone Applicant G L Tel. # Zqj 1d /0 Address L WIh D!D/)74-Lic.# Owner N+N i C S, Y TfiEET L Address STATE U Architect Address Size New Area: Ft. Front Overall Ft.Deep Overall Total Area Garages Lavatories No. of Families No. of Stories / Construction _Bathrooms Rooms 1st 2nd 3rd i Size of Lot Dist. from Street Line Dist. from Side Street Line Purpose of this Permit 'f 2CJL VLJ 141 l.liY _. T/ I/t City ter Well Septic Sewer Approved by Date P- -2 BWA dies I hereby agree to conform to all th requirements of the Laws of the State of Connecticut and the Ordinances 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 distanc s from all oth r zon s and is located in a zone in which this building and its use is allowed. Signed I hereby apply for a Certificate of Occupancy for the work described in this application for permit. Signed DO NOT WRITE BELOW THIS LINE— Footing Framing INSPECTION RECORD VALC —` Foundation Fireplace/Chimney Insulation Dc O Plumbing Permit# Inspections: HVAC Permit# / l 7L Inspections: Electrical Permit# [ Inspections: `—Qa K iccr4t`bK Sprinkler Permit# Inspections: PERMIT # DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT Application is hereby: TOWN OF SOUTH WINDSOR APPROVED DISA BUILDING INSPECTION DEPT. 644-2511 Ext. 230 Application must be printed or typed. Date Building Ins r 1. LOCATION OF JOB Mallard Place) IZ bA-K.F,,k FEE SCHEDULE No . Street 60t''b 0 - $19000 -10. 00 Floor Apt . No. Over $1 ,000 -10.00 per $1 ,000 or 2 . OWNER r— fraction thereof K3. ADDRESS Z L - WIN V7-:6e, G4--, 4. APPLICANT md!JL,, N*Iqex Li• y-+P0 5 . ADDRESS 6Z w-lb<zk= 6. ESTIMATED COST $ 50V 7 . IS THIS A CONTRACT COST Yes 8. FEE ENCLOSED $ Q 9. TYPE OF BUILDING: RESIDENTIAL COMMERCIAL 10. TYPE OF JOB : Original Installation X..Alteration/Addition/Repair BD 3A 11/88 APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side) 11 . LOCATION OF JOB (Tj Vic: NO . STREET APT. NO 12 . TYPE OF INSTALLATION 13. SIZE OF MAIN FEEDER 14 . NO. OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS 16. NO. OF POWER LOOPS 17 . NO. OF LIGHT OUTLETS 18 . NO. OF HEAT CIRCUITS 19 . NO. OF POWER OUTLETS r1 20. NO. OF CONVENIENCE OUTLETS " 21 . NO. OF HEAT CIRCUITS 22 . NO. OF POWER CIRCUITS 23. NO. OF LIGHT CIRCUITS 24. SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS 26. NO. OF PANELS 27 . TOTAL WATTAGE 28 . NO. OF POWER FEEDERS 29 . NO. OF SWITCHES 30. A/C LOAD 31. SIZE OF POWER FEEDERS 32 . NO. OF FIXTURES 33 . TOTAL HORSEPOWER 34 . NAME OF SUBCONTRACTORS AND THEIR TRADES 35 . REMARKS AND FURTHER DETAILS : r LICENSE NO.SIGNATURV OF A PLICANT ATE PHONE NUMBER: L 9L4-L /7 FOR OFFICE USE ONLY APPLICATION FOR HVAC PERMIT DATE: J - cp o - Sy N0. TOWN OF SOUTH WINDSOR EST.COST,- BLDG. PERMIT NO.1540 SULLIVAN AVENUE FEE SOUTH WINDSOR, CT 06074 FEE : 644-2511 - Ext. 230 0 - $19000 - $10.00 44 6 1000 or fraction LOCATION OF BUILDING jD thereof - $10.00e2Zjjr4Wg 4 Zha 4 AJa_ 4&Z16C d,0 V/14 0 ER ADDRESS TOWN PHONE NO. ov fZ a f Z t c We— vq 1.7CONTRACTORADDRESSTOWNPHONENO. TYPE OF SYSTEM: HEATING TYPE OF BUILDING: RESIDENTIAL_ A/C COMMERCIAL VENTILATION BUSINESS INDUSTRIAL IF HEATING: STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. HYDRONIC_,Nc). WARM AIR UNIT RADIANT HEATER (INCLUDING WOOD COAL BURNING STOVE) TYPE OF FUEL: OIL-GPM GAS IN-PUT_)O ELECTRIC KW WOOD COAL OIL TANK - SIZE & LOCATION: INSIDE OUTSIDE CAPACITY LPG TANK - CAPACITY EXISTING RADIATION ADDITIONAL RADIATION aJ TOTAL RADIATION DESIGN TEMP. OUTBID F INSIDE OF DIFFERENCE OF 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) IF AIR CONDITIONING: DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE F TOTAL HEAT GAIN (BTUH) HEAT GAIN SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL COOLING EQUIPMENT (INCLUDING MAKE & MODEL NO.): TONNAGE COOLING CAPACITY (BTUH) IF VENTILATION: DESCRIBE ALL AIR-HANDLING EQUIPMENT (INCLUDING KITCHEN EXHAUSE EQUIPMENT): TOTAL SIZE OF SYSTEM (CFM) FRESH AIR INTAKE (CFM) PLAN MUST ACCOMPANY APPLICATION) The undersigned hereby applies for a permit to perform the following work and is to comply with all local ordinances and State of Conn. Building Codes in the performance of such work. FURTHER DESCRIPTION OF WORK: STATE LICENSE - NAME & TYPE #DATE S fG APPLIC 0 ED DATE D 4A 11/88 I - B- R CALCULATION SHEET 1503 (Modern Method) Copyright 1977 by The Hydr nics Institute OWNER ADDRESS DESIGN TEMPERATURE DIFFERENCE F. DATE COL.A COL.B COL.C COL.D COL.E COL.F COL.G 1 ROOM Q O H L W H L W H L W H L W H L WOeslyn Water Temp. 2 ROOM DIMENSIONS, FT.U BTUH per F t f 3 LENGTH EXPOSED WALLS,FT. Radiation Selected 4 WINDOW AND OUTSIDE DOOR AREA U. BTUH BTUH BTUH BTUH BTUH 5 WALL CONSTRUCTION ROOM LIN.FT.OF Table 9,Line 3 x H) TOTALS RADIATION 6 TYPE OF GLASS FROM LINE 12 SELECTED Bottom of table used f r Line 5) 7 CEILING CONSTRUCTION C Table 9,L x W)D B FLOOR CONSTRUCTIONt Table 9,L x W r Lin. F t 1 E 9 COLD PARTITION CONSTRUCTION F Table 9,L x H)G 10 _0 1 Wall(With Openings)O 2 Wells(With Openings) J1.0 1 3 Walls(With Openings) or Ent. Hall I. I TOTAL BTUH AT 70F TEMP DIFFERENCE' 12 TOTAL BTUH AT DESIGN TEMP. OIFFERENCE K COL.A COL.0 COL.H COL.I COL.J COL.K COL.L TOTAL BTUH TOTAL 1 ROOM OF BUILDING RADIATION ix AT SELECTED O H L W H L W H L W H L W H L W DESIGN TEMP-* 2 ROOM DIMENSIONS,FT f' DIFFERENCE u 3 LENGTH EXPOSED WALLS, FT. a 1 WINDOW AND OUTSIDE DOOR AREA a BTUH BTUH BTUH BTUH BTUH 5 WALL CONSTRUCTION INCREASE BATHROOM Table 9,Line 3 x H) TOTAL 20% 6 TYPE OF GLASS Bottom of table used for Line 5) tFOR CONCRETE FLOOR ON7CEILINGCONSTRUCTIONGROUNDORFILLAT Table 9,L x W)GRADE LEVEL,USE LINEAR B FLOOR CONSTRUCTIONt FEET OF EXPOSED EDGE Table 9,L x W r Lin Ft.) 9 COLD PARTITION CONSTRUCTION Table 9,L x H) 10 -c 1 Well(With Openings)G 2 Walls(With Openings) D X J 3 Wells(WIth Openings) or Ent.Hall I- 11 TOTAL BTUH AT 70F TEMP DIFFERENCE' 12 TOTAL BTUH AT DESIGN TEMP. DIFFERENCE FORM 1503 This form Is available fr m The Hydronlcs Institute,35 Russo Place,Berkeley Heights,N.J. 07922