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DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#TOWN OF SOUTH WINDSORApplicationishereby_:
BUILDING DEPARTMENT Q
PPR EQ 1540 SULLIVAN AVENUE
Bldg.Permit#644-2511 ext. 230
t to4 Building Inspector
J!alication must be printed or typed
FEE SCHEDULE Location ofJob:
2-- S —)P)\,r R a
0-$1,000=$13.00 Street No. Street Lot No.Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT rM 4>CC X CAQ`
APPLICANT ADDRESS "\%WU vo C
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APPLICANT PHONE#
OWN S OWNER n Cs-r-t- S 0 U 0 rYq<
OWNER ADDRESS 2 o 2
OWNER PHONE
ESTIMATED COST$
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IS THIS A CONTRACT COST? dyes 0 No
M1 Y. eta.;a •
FEE ENCLOSED$
0R CO TYPE OF JOB:
D Original Installation
AAlteration/Addition/Repair Revised 8/99
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE CT YSTEM: 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
XISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
t ,E Ccy_s o v of
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D a'.A.p c
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) o
TYPE OF FUEL
OIL—GPM GAS—INPUT ELECTRIC—KW
OIL TANK SIZE&LOCATION
INSIDE1 OUTSIDE CAPACITY 21 S LPG TANK CAPACITY
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 EJU\ h
QJI2^
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a 0
E UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO RFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE