HomeMy WebLinkAbout22 Evans CrossingDEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Application is hereby:TOWN OF SOUTH WINDSOR PERMIT#
SBUILDINGDEPARTMENT
APPRO D 1540 SULLIVAN AVENUE Bldg.Permit#
U Jam_ 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE 1
Location of Job:
0-$1,000=$13.00 Street No. S t Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS I3 12Kz
APPLICANT PHONE# 0,26 C
O W H St OWNER
4 000,
OWNER ADDRESS Orr'1''i,-
OWNER PHONE g;1
C ESTEWATED COST$
IS THIS A CONTRACT COST? O Yes -NOk
FEE ENCLOSED$ _ 41C AP 40
SOR.Cod TYPE OF JOB:
New Installation
0 Alteration/Addition/Repair Revised 5101
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
R TIEATING WVESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
I YDRONIC WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
J DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
Z
GROSS HEATING CAPACITY(INPUT—BTUH) //2aOe NET RATING(OUTPUT BTUH)
TYPE OF FUEL
L--GPM . ;J 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.
7- 44
CONTRACTORS LICENSE NO. TYPE STATE
67SIGNATUREOFAPPLICANTDATES -