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DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Application is hereby:TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT 101 (O
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
4/dO i oN— 644-2511 ext. 230 3 S
bati Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C ,
APPLICANT ADDRESS
APPLICANT PHONE# k31A 1A- 2 S
OWN S OWNER 1
OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$ C3
U
IS THIS A CONTRACT ST? Yes No
FEE ENCLOSED$
f TYPE OF JOB:dS'OR.Cps New Installation
teration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
EATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
O STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
0 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(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT BTUH) NET RATING(OUTPUT—BTUH)2 1
TYPE OF FUEL
OIL—GPM OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
N 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 Q P
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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE Z a Q
I = 8 • A CALCULATION SHEET 1503 lMod n Method)
CoprrlEnt Is»by Tn.Hyde nice I••atlr..t.
CeA` OESI N T[M ERATUAE IFFIERENCt f. OAT[
MfN[A A \1t 1 AOORNSS
COL.F c L.G
COL.6 COL.C COL.O COL.E
I ROOM W H L w H L w Design wale• Ten+F.a'6Q
c w H L W H L
I- 580 i h ZO /
TUN fv' t el
R OM DIMENSIONS,FT. U
Radiation i•I.cle
3 LENGTH EXPOSED WALLS.F, t
4 WIN O'w ANO OUTSIDE DOOR AREA TUN 9TUH TUH
TUN STUN
R M LIN. FT.Of
I ; ALL CONSTRUCTI N O TOTALS RADIATION
ITaoI.9.
FA M LINE It i[L[CT[O
Lino 3 a M1
30bITrrEOFGLASS 8 d d
16 stern I toWo wood lot Line 61 C
1 CEILINGCONSTRUCTION 05 p
ITev"9.L a W1
j PLO R C NSTRUCTIONT
ITlilao9.L w r0h.F41 Is!
COLD PARTITION CONSTRUCTION a
17001
9.L a 141 M
10 1 was IWltw Ooonlneal 0/Z
1
4 x2wellstwillOg»nr 1
2 wall,Iw.tw o.wlr.wl o.Ent.H NI r-
11 TOTAL IITUtt AT 7611 TG&AF DIFFERENCE O K
12 T TAL STUN AT DESIGN TEIM. DIFFERENCE L
COL.I COL.• Co L.K COL.L TOTAL GTUH TOTAL
C L.A COL.m COL.H OF BUILDING RADIATION
AT SELF TED
I A OM t N L w H L W O[iION TtMF.•
O "
LwHLwH w oIFFEw[rIc[
21 ROOM 0164EN61 MS.FT u
3 LIN TH EXPOS60 WALLS. FT. t
u
4 WINDOW AND OUTS$ E DOOR AREA
STUN •STUN BTU" STUN•
TUN INCREASE OATHAOOM
TOTAL 20A
6 WALL CONSTRUCTION
ITeOIo 9.Lmis 3 a HI
6 TYFE F GLASS IFOA CONCRETE FLOOR ON
Igetton+ I to01 Teed Ior Line SI GROUND OR FILL AT
T EILING C NSTRUCTION GRADE LEVEL.USE LINEAR
FEET OF ExPOSED EDGE
ITaae 9.L a IN)
6 FLO R CONSTRUCTIONI
I T a01e 9.L a w or Lin F t l
COLD fARTITt N CONST RUCTION
ITa01e 9.L a HI
10 - 1 well IWITN o•ninf•1
i; 2well.Iw610% 0•w.n oJ
2 Weil•IwitA Opening&)04,Enl Vail r
I1 TOTAL IIfUH AT 700; TEaA DIFFERENCE'
t? TOTAL I;U; AT DESIGN TEM DIFFERENCE - FORnA ISO
Tnre I irw Is•.aMeoie born Tn.Hvdr nice inamwie 36 Russo Place.601li610Y H.ignla,N 1 01922