HomeMy WebLinkAbout1535 John Fitch Boulevard (22)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR(:
S yBUILDINGDEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
C 1&L
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Loccaation of Job:
Jo& /`t`C 4
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS E5G :J ` Cj r
ov
APPLICANT PHONE#
i
OWN 3 OWNER M1Z IJC
OWNER ADDRESS j L—V Ds
Y i I
w
OWNER PHONE I
C ESTIMATED COST$ 3 GL —
U
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ 4 5.CC7 I
TYPE OF JOB:dsoR,C43 New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
WHEATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRES URE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
ElHYDRONIC UARM 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.)
C2,NPk M AJ E-10ADNG
GROSS HEATING CAPACITY(INPUT—BTUH) 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 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)
GA S F 12.cp U M l i' 4 C l s c::-,(r U cCj
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.
Sl32 Z cT
ICN RACTORS LICENS TYPE STATE
QSIGNATUREOFAPPLICANTDATE -
r