HomeMy WebLinkAbout25 Chapin StreetDEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT r(?G
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
I(Aj 3 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
io
0-$1,000=$15.00 Street No. Street Lot No.Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 1
APPLICANT ADDRESS S
1 C_ - p o
APPLICANT PHONE#
O W N S F OWNER Ovyh — o
q
OWNER ADDRESS
0.
OWNER PHONE S Ic1 --
C ESTIMATED COST$ 2coT)O
IS THIS A CONTRACT COST? Yes 7C No
FEE ENCLOSED$ 20,,Z10
TYPE OF JOB:
sOR-CO New Installation
7 Alteration/Addition/Repair
Revised 410IH2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
0 HEATING X RESIDENTIAL
A A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC DfWARM 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 HEATI G QIMENT(
I(
INCLUDING MAKE&MODEL NO.)
C '
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT BTUH) Gol cC
TYPE OF FUEL
OIL—GPM OIL TANK LOCATION:INSIDE OUTSIDE CAPACITY
0 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 COOLJLN>GG EQUIPMENT(INCLUDING MAKE& ODEL NO.)
TONNAGE COOLING CAPACITY(BTUH) a
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 1
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 O. T E STATE
SIGNATURE OF APPLICANT DATE