HomeMy WebLinkAbout250 Abbe Road (15)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT ivy K i
Application is hereby:TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE Z o l g 67
za-644-2511 ext.230
Date Building Inspector Application must be printed or typed
Location ofjob
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER r—
or any fraction thereof
ADDRESS
OWNERS PHONE#
APPLICANT
w N SF,q
ADDRESS S t n^ L
O
ESTIMATED COST $ /p
O
C IS THIS A CONTRACT COST?
a 4 V
Q YES NO
Sr
T ICJ FEE ENCLOSED $ y
r
Sp .CO TYPE OF JOB:R Original Installation
Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS.HIGH PRESSURE LIMIT LBS.
E/HYDRONIC WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION `'r ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
TOTAL HEAT LOSS(BTUH)
HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT (INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING (OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM y GAS-INPUT ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
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
WORKTHEUNDERSIGNEDHEREBYAPPLIESFORAPERMITTOPERFORMTHEWORKDESCRIBEDANDISTO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN. BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK
1
STATE LICENSE-NO. NAME&TYPE SIGNATUREOF APPLICANT
PHONE NO. r'f 6 4L/ DATE d ly