HomeMy WebLinkAbout1535 John Fitch Boulevard (18)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT#
Application is hereby TOWN of SOUTH WINDSOR
4
BUILDING DEPARTMENT Bldg Permit#
APPRO 15.10 SULLIVAN AVENUE
6 J 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location ofjob
Rnrat Alm
Street No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt. No.
Over $1,000
12.00 per$1,000
OWNERoranyfractionthereof it
ADDRESS
OWNERS PHONE# 0
APPLICANT_4V 14CIr°
0 1 ADDRESS 1<0
4(
0) ; ESTIMATED COST $0 E•,,
C IS THIS A CONTRACT COST?
S NO
r FEE ENCLOSED $
SOR-CO TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
1
mil
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING RESIDENTIAL
A/C COMMERCIAL
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 F INSIDE F DIFFERENCE,O F
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)
TYPE OF FUEL
OIL-GPM GAS-INPU10% 7 ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
AIR CONDITIONING
DESIGN TEMP. OUTSID)r F INSIDE '/_SF DIFFERENCE O_F
TOTAL HEAT GAIN(BTUH) 00099'
HEAT GAIN SHEET MUST ACCOMPANY PLCATION)
DESCRIBE ALL COOLING VQUIPMENT (INCLUDING MAKE&MODEL NO.)
call)
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44R : jl!%W-
u
TONNAGE COOLING CAPACITY(BTUH(7Z O
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
All
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) d00
PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WORK Aidf4 'fo r
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
STATE LICENSE-NO. NAME&TYPE SIGNATURE bF OPLIC NT
PHONE NO&M DATE 1,111,47 1:'