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DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT i
PERMIT#
TOWN OF SOUTH WINDSORApplicationishereby: BUILDING DEPARTMENT 510
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
G^
644-2511 ext. 230 IAfyJ 9
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
h s
0-$1,000=$15.00 Street No. Street Lot No.i
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
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APPLICANT E0 d 14e f 4 C&c (r
APPLICANT ADDRESS
APPLICANT PHONE#o2g p ' 02
N S OWNER _l - v
0.
OWNER ADDRESS 7I-rR
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OWNER PHONE i
C ESTIMATED COST$3 0o a
IS THIS A CONTRACT COST? ` Yes No
FEE ENCLOSED$ 'yS- v
TYPE OF JOB:
S0R'CO New Installation
Alteration/Addition/Repair 1
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
i HEATING URESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC 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)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.) ,
3 S-c c+ < fir 0 z C..
GROSS HEATING CAPACITY(INPUT—BTUH)JW,oCP NET RATING(OUTPUT—BTUH) L
TYPE OF FUEL
IS'OIL—GPM AIL TANK LOCATION:Ed INSIDE OUTSIDE CAPACITY Z 7 J
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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE `y " j' -O Z,