HomeMy WebLinkAbout20 Berle Road (12)DEPARTMENT DECISION
APPLICATION FOR H PERMIT#VAC PERMIT
Application is hereby:TOWN of SOUTH WINDSOR
10 3 g y
BUILDING DEPARTMENT Bldg Permit#PRO 1540 SULLIVAN AVENUE Al AAuLezyge,644-2511 ext.230
Date Building Inspector
Application must be printed or typed
Location ofjob
Street No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt.No.
Over $1,000
12.00 per$1,000
OWNER Ayioranyfractionthereof G A,\L F-o ST E fZ
ADDRESS_ 0
Sou-H Wirv scs C 0ro ? L
OWNERS PHONE# 6 '4 41 v
APPLICANT Fl Cis P'r l%_ b iM
pW N S ADDRESS I(A V"re A L, S"r.
ESTIMATED COST $
IS THIS A CONTRACT COST?
YES NO
a FEE ENCLOSED $
sQR.CO TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING L0,00,RESIDENTIAL L-
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS.HIGH PRESSURE LIMIT 30 LBS.
HYDRONIC Po"" WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION 5 ADDITIONAL RADIATION N O TOTAL RADIATION
DESIGN TEMP. OUTSIDE 6 F INSIDE_70_F DIFFERENCE 7 4D F
TOTAL HEAT LOSS(BTUH) 92,6-D70
HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT (INCLUDING MAKE&MODEL NO.)
SLfNN'r F) N L -vo- P G1: F 'rc-i R o 0 tog
GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING (OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM I. I GAS-INPUT ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY d 7S LPG TANK CAPACITY
ell 6-riJJ`.. —
AIR CONDITIONING
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
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 c C4 C4c
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.
3?15 1a9 6--1 DJ-.
STATE LICENSE-NO. NAME&TYPE SIGNATURE OF APPLICANT
PHONE NO.Aft — ;92"Lf(q,3 DATE )hqq