HomeMy WebLinkAbout140 Commerce Way (3)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT#
Application' ereb :TOWN OF SOUTH WINDSOR o2 O
BUILDING DEPARTMENT
AAYPP O 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date BuAA6g Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=R
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT IvierzkJ"i L
APPLICANT ADDRESS 13d l
APPLICANT PHONE#J LTI lC" Ze Z
W N S OWNER tii,`C OV 17 G f
4 OWNER ADDRESS 0 (I eSO60rAfRS
O •:;
OWNER PHONE
C I'D ESTIMATED COST
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ 7
TYPE OF JOB:
OR-Co New Installation
Z eration/Addition/Repair
Revised 4/01H2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
VEATING RESIDENTIAL
A/C COMMERCIAL
I 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) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT UDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT-BTUH) SG'1),0 NET RATING(OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
AS-INPUT LPG TANK CAPACITY ELECTRIC-KW
AIR CONDITIONING
DESIGN TEMP.OUTSIDE G)0 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)
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
TOTAL SIZE OF SYSTEM(CFM) O400 FRESH AIR INTAKE(CFM)
PLANS MUST ACCOMP 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.
30321e-) S-- l
CONTRACTORS LICENSE NO TYPE STATE
SIGNATURE OF APPLICANT DATE 7