HomeMy WebLinkAbout16 Kupchunos DriveDEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Applicati y:TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230 y
Date B Id' Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
6 U oJ,
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS _
APPLICANT PHO #
O W N St OWNER
At 4 OWNER ADDRESS Z6
r'
OWNER PHONE Le
C ESTIMATED COST$ 3
IS THIS A CONTRACT COST? (- Yes No
l FEE ENCLOSED$ V r If
ov
TYPE OF JOB:
soR, o
New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OFF SYSTEM: TYPE OF BUILDING:
014EATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
ST AM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
U-ffYDRONIC WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
T
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
D ClTE ALL HEATING`PMElJT(INCLUDING M 7DEL;iO.) /
ya 67"
I
GROSS HEATING CAPACITY(INPUT-BTUH)I D NET RATING(OUTPUT-BTUH) A
TYPE OF FUEL
3-61-L-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
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.
r 303//,3 S --/ Ct
CONTRACTORS LICENSE NO. TYPE
r
STATE
SIGNATURE OF APPLICANT G DATE 1