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DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
TOWN OF SOUTH WINDSORApplicationishereby: N
BUILDING DEPARTMENT 5 C0
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Locati n of Job:
z CA 0
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS P 0
APPLICANT PHONE#
SFq OWNER
0 N T2'SGt ,JD s
OWNER ADDRESS 17 C
3
a
OWNER PHONE S, S' .3 F 6
C ESTIMATED COST$
V
IS THIS A CONTRACT COST? es No
FEE ENCLOSED$ 3C>
TYPE OF JOB:
SOR O CO wN 1eInstallation
A
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF 'STEM: TYPE OF BUILDING:
HEATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
FEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
C7 HYDRONIC WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION 9 Y`ADDITIONAL RADIATION Z 3 ' TOTAL RADIATION 117
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE TALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
C/,,*l..Z/ c -/Q' - P/U'V A, 0C /1/1-41, rU4
4"Le/ -;>3, ye
GROSS HEATING CAPACITY(INPUT BTUH) 5 NET RATING(OUTPUT—BTUH)
TYPE OF FUEL
OIL—GPM OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
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 /'i2 1.U1' f c AIZ4
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.
oo " 7 D : 5 / L—
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT SATE
I , I
ALLIED PLUMBING SUPPLY, INC.
AVENUEFRANCIS14ANUE
f . B= R CALCULATION SHEET 1503 (Modern Method) HARTFORD, CT 06106-2101'
II1 All
ADDRESS `S /hAR 7 LQ,VC—S6 W//p 20 0DESIGNTEMPERATUREDIFFERENCEF. DATE
i COL.A COL.B COL.C COL.D COL.E COL.F COL.G
1 •ROOM G0/f/o/
li O H L W W H L W H L W H L W Design Water Temp.
ROOM DIMENSIONS FT. 1'- 6iU
S
BTUH per Foot of ffp ilLENGTHEXPOSEDWALLS, FT. Q Radiatl n Selected
WINDOW AND OUTSIDE DOOR AREA U.
BTUH BTUH BTUH BTUH BTUH
WALL CONSTRUCTION
ROOM LIN.FT. E,Table 9,Llne 3 x H) U s / 706 TOTALS RADIATIt''
TYPE OF GLASS FROM LINE 12 SELECTED
Bo&m of table used for Line 5) 6 Soo r
CEILING CONSTRUCTION C
Table 9,L x W) 00
FLOORVONSTRUCTIONI D G 7 Pv
Table 9,L x W or Lln. Ft.) r Oj 06 E -p* i
COLD PARTITION CONSTRUCTION F QfY9L it
TsbIs 9,L x H)
jii0 C 1 Wall(With Openings) OOG 1
2 Wells(With Openings) e X H
I •iw
b 3 Wells( Ith Openings) or Ent. Hall Iw
J
Oj O 0
I
1 TOTAL BTUH AT 70F TEMP, DIFFERENCE*
2 TOTAL BTUH AT DESIGN TEMP, DIFFERENCE X,vG Q K
L
I4
COL.A COL.B COL.H COL. 1 COL.J COL. K COL.L TOTAL BTUH TOTAL;
1 ROOM OF BUILDING RADIATIO
a AT SELECTEI
p H L W H L W H L W H L W H L W DESIGN TEMP.°
H DIFFERENCE
2 ROOM DIMENSIONS,.FT.
U
13 LENGTH EXPOSED WALLS,FT. Q
4 WINDOW AND OUTSIDE DOOR AREA U.
BTUH BTUH BTUH BTUH BTUH
WALL CONSTRUCTION INCREASE BATHROOM
Table 9,Line 3 x H) TOTAL 20%
Ir67TYPEOFGLASS(
Gott m of table used for Line 5)
iFOR CONCRETE FLOOR ONCEILINGCONSTRUCTION(
Table 9, L x W)
GROUND OR FILL AT
GRADE LEVEL,USE LINEAR
B FLOOR CONSTRUCTIONI FEET OF EXPOSED EDGE,
Table 9,L x W or Lin. Ft.)
9 COLD PARTITION CONSTRUCTION
Table 9,L x H)
10 _C 1 Wall(With Openings) o 94t .
2 Walls(With Openings)2 Xjo
1
I 3 Wells(With Openings) or Ent.Hell FJ
tl TOTAL BTUH AT 70F TEMP, DIFFERENCE'
1I TO-r' ' Tlllr PT I nIFFFnENr1-