HomeMy WebLinkAbout16 Brookhaven Lane (2)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: yBUILDINGDEPARTMENT
APPRO y 1540 SULLIVAN AVENUE Bldg.Permit#
Qz—
644-2511 ext. 230
Da a Building Inspector
Application must be printed or typed
Location of Job:
Fo
E SCHEDULE
b
1,000=$13.00 Street No. Street Lot No.
ver$1,000=
3.00 per$1,000
y fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
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APPLICANT PHONE# 2 l1
F
OWNER
q OWNER ADDRESS f 1 y-
OWNER PHONE 4?2r y- ---3 G y
C ESTIMATED COST$2 ri-C
IS THIS A CONTRACT COST? 0-Yes 0 No
CJ FEE ENCLOSED$
TYPE OF JOB:
SO R'CO M ew Installation
O Alteration/Addition/Repair Revised 8/99
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF BUILDING:
HEAT IG— ENTIAL
ualuc 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 OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) F(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 OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW
AIR CONDITIONING
DESIGN TEMP. OUTSIDE S °F INSIDE_OF DIFFERENCF)-5' OF
TOTAL HEAT GAIN(BTUH(HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
D SCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
l/A', a 3
2j
TONNAGE o7 COOLING CAPACITY(BTUH).3LZZ,/
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
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.
joi r z s / C4-
CONTRACTORS LICENSE NO TYPE STATE
SIGNATURE OF APPLICAN DATE
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