HomeMy WebLinkAbout20 Baker Lane (14)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR 6 9 a o
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 S'
late Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
0-$1,000=$13.00
Tenant
eet No. Street Lot No.
Over$1,000=
13.00 per$1,000 Apt.No.
or any fraction thereof Designation p
i
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE# 7
OWNER
OWN S
letOWNER ADDRESS 6 l ;C5 ^ Fq 0 u-y f
OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST"? Yes No
FEE ENCLOSED$ P
c
r w
TYPE OF JOB:
SpR'CO Qew Installation
13 Alteration/Addition/Repair Revised 8/99
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 C WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONA DIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF /? E e DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) F(FIEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
C, L—n r (0,d/,
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH)
TYPE OF FUEL
OIL—GPM OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
44 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)
10 5 /-v je', fCee.-y G 4 f< z?1J4
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.
00 3 03 lo2,f
CONTRACTORS LICENS STATE"
SIGNATURE OF APPLIC DATE!