HomeMy WebLinkAbout252 Long Hill RoadVlv
0
1.0 THE BUILDING INSPECTOR
of the APPLICATION FOR
PLAN EXAMINATION AND
Q TOWN OF SOUTH WIMSM CAN- BUILDING PERMITI z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX.0
l ZONING S
I• AT (LOCATION)hQ N Q I'I I I R DISTRICT 4
LOCATION NO.) STREET)
OF BETWEEN AND
BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking' most recent use
T
1 tZ New building Residential U dam/ Nonresidential
2 Addition(If residential, enter number 12® One family 18 Amusement, recreational
of new housing units added, if any,13 Two or more family — Enter 19 Church, other religiousinPartD, 13)
number of units— — — — -i 20 Industrial
3 Alteration (See 2 above)14 Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory — Enter number
22
5 Wrecking (If multifamily residential, of units ——————— — -i Service station, repair garage
enter number of units in building in 15 S Garage 23 Hospital, institutional
Part D, 13) 16 Carport 24 Office, bank, professional
6 Moving (relocation) 25 E] Publicutility17 Other — Specify
7 Foundation only 26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 R Private(individual, corporation,
28 Tanks, towers
nonprofit institution,etc.) 29 Other — Specify
9 Public (Federal, State, or
local government)
C. COST Omit cents) Nonresidential — Describe in detail proposed use of buildings,e.g.,f ad
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement................ school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical......................
b. Plumbing ......................
c.Heating, air conditioning.........
d. Oth r(elevator, etc.)............
TT11. TOTAL COST OF IMPROVEMENT 3 i0 ODV
III. SELECTED CHARACTERISTICS OF BUIL ING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry(wall bearing) 40 Public or private company
48. Number of stories................ 0*1
31 ® Wood frame 419 Private (septic tank, etc.)
49• Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions ....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 Other — Specify 42 Public or private company 50. Total land area, sq. ft. ........... Q ODd
43® Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES Z51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors.......................
36® Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 El ctricity 44 Yes 45® No 53. Number of b dro me..............
38 Coal
39 Oth r— Specify Will there b an elevat r?
54. Number of
Full..........
46 Y s 47 No bathr me
Partial........
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, czt y, anti State ZIP code Tel. No.
O1.wner or Vy NOri f 5 OI_`
15--&If.
Lessee
10 V ICf
2.
Contrac+or
3.
Architect or
Engineer
The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signature of applicant Address Application date
roe64
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD —_For office use
Plans Review Required Check Plan Review Date Plans By Y
Date Plans B Notes9FeeStartedApproved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval I Check Date Number B Permit or Approval I Check Date Number ByPpObtainedyppObtained
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building r
Permit number y_
Building
Permit issued zL l9 ! 19
r,
Building Orl9 d10
Permit Fee $
rove y:
ITLE
I
i
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date June 19
v 19 8 4
E
Fee Paid $. 2.7 6..0 0 Est. Value $. .4 6.it 0 0 0
Pit N' 13901
on the side of
Lot #2 Long Hill Road SaYct
Street No. 252
Owner Marcel Clavet
Applicant Marcel Cla ve t
CERTIFICATE OF OCCUPANCY ISSUED:
20 .00
RKD.ft. TIC PAYMMI I
No. 6 814
Fee Paid $ 3 .0 0
CLASSIFICATION
Dwelling
BUIIDlNG PERbffr
N'? 13901
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. June 19 19 84
94to is to Certtfg, That Marcel Clavet
is hereby granted permission to Dwelling
at estimated value of $ 4 6,0 0 0
on the side of Lot ,4 2Long Hill Road Street on land
owned by MArC&lCl ayet
Said Work to be as described in Application
No. 14 2 01 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Iss'ued June 19 ig 84
fit;,, .• t• :
e--Building Inspector.
Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers
during the day and by both barriers and colored lights by night.
SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place
or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a
license therefor from the city or borough in which such highway may be situated, he shall pay said city,
town or borough all costs and damages which it shall sustain, or be compelled to reason therefor"
nwel. ing - Lot #2 6/19/84
IMarcel Clavet
252 Long Hill Road
Permit # 13901I
i
I
Electrician Richard Barrett # 8441L-"
H ating Contr. Marcel Clavet # 6063
Plumbing " Marcel Clavet # 6543
Oil Burner
C rtificate of Occupancy 6814
Sewer Permit - (Septic)
Plot plan apprd. per Engr.
P Irmit No. L131 TOWN OF SOUTH WINDSOR
SOUTH WINDSOR, CONN.
Permit
a
Certificate of Occupancy
T S TO !CRRTIFY #hat the Aj"
at No in th own of South Windsor, Connecticut, has
been erected and c pleted in accordance with theBuilding Code and Zoning Regulations of
the Town of South Windsor, and is hereby approved for o pancy.
Building Inspector
Owner, Builder O
Fee Paid Date 191` y
8441
ELECTRICAL APPLICATION
Application No. 9 S 4 7
on the Side of
Lot #2 Long Hill Road Strwt
Street No. 252
Owner Mar _P 1 Clavet
Electrician Ri nhard RarrPtt
FILED IN OFFICE OF
The Building Inspector
Mine 26 19JU_
INSPECTION.
M No Electrical Work shall be started until a Per-
mit is granted by the Building Inspector.
In New Buildings no wiring shall be started
until the plumbing and heating pipes, and the fire
stops (if of wood) are installed, without a special
permit from the office of the Building Inspector.
Electrical Permit No. /
Master License No. .../..® ... ..........
TOWN OF SOUTH WINDSOR Building Permit N 3 '0
BUILDING DEPARTMENT Date Filed . (!/.1. .................... .........
Date Final Approval ................ ..........................
APPLICATION FOR ELECTRICAL WORK
Electrical Inspector
JOB LOCATION: JOB OWNER: ..
tOo Side of etween and -
Name of Buildin g C,!Q-,L-Owner Address
If work is for Lessee--Give name Address ........................................... ................ .... ..................
Building now occupied as (unless new)tttF No. of family units now .
Building to be occupied as ..... tD l V ... .. ...... . Number of family units to be
Is this work included in a Building Permit? t. Permit Fee .. ..... ...`"—..
U If no Building Perm'
Permittee l 5, ` Business Address C)f tplm, A... ... Telephon6. ..
COSTOF INSTALLATION:
TO BE FILLED OUT BY PERMITTEE
TO BE WIRED I EXISTING APPLIANCES
Number of light outlets to be installed
Number of convenience outlets to be installed Number of present Appliance Circuits ..... ... .... .. .... ... .. ...
Number of switches to be installed
Number of appliances to be installed . . Do these include Range Water Heater
as listed below) Dryer Air Conditioner Oil Burner
TYPE RATING NO.
Dish Washer Gas Burner
Range
Well Pump Elec. Heaters
Range Top . . . . . .
Oven . . . . . . . . REMARKS:
Water Heater
Clothes Washer
Clothes Dryer . . . . .
Dish Washer . . . . . .
Air Conditioning Motor . .
Oil Burner Motor . . . .
Gas Burner . . . . . .
Circulator Motor . . . .
Attic or Large Fan
Well Pump . . . . . .
Electric Heat . . . . .
Other . . . . . . .
Number of new Lighting Circuits
Number of new Appliance Circuits . . . ...... „ ..........
Number of Heating Circuits
Number of Motor Circuits .
Size of present service
Size of service to be . .... ............
6543
PLUMBING APPUCATK)N
gppliCation IN&L 7319
on the side of
Lot #2 Long Hill Road StrQt
Street No. 252
Owner Marcel Clavet
Plumber Homeowner
Filed in Office of
The Bwl&ng Iaapectior
Oat -3 - —19 24
TV
No person shall 2" 0 Or alder aw
portion of the dmimp qmw of my bu&img
Cccem to repair 66) Una a pemit is gCosed
by the BuMmg Impeaw.
APPLICATION FOR PLUMBING PERMIT (Continued from Reverse Side)
TOWN OF SOUTH WINDSOR, CONN.
11. LOCATION OF JOB 6 cq
NO. SIMEET FLOOR APT.NO.
GENERAL PLUMBING
12. KIND OF INSTALLATION lj( to C5 14 <1 13. SIZE OF MAIN DRAIN
14. NO. OF TOILETS STYLE 15. NO. OF URINALS STYLE
16. NO.OF BATHTUBS- a2 —17.NO.OF LAVATORIES 18. NO.OF SINKS 19. NO. OF WASHTUBS
ii
20. NO.OF CONDUCTORS SIZE 21. NO. OF STACKS_ _SIZE
22. AREA OF ROOF r 23.NO. OF CATCH BASINS Vc V e 24. NO. OF FLOOR DRAINS
25. NO. OF OTHER FIXTURES KIND
26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? ® 27. SIZE OF WINDOW
28. IF NO WINDOW, WHAT KIND OF VENTILATION IS THERE? F-0-0 - '25, C. &
29. SIZE OF DUCTS 30. ARE SEWAGE AND WATER FACILITIES AVAILABLE? A/O
SIGNATURE ADDRESS /6 111670-'/ 4,(kOAJ
LICENSE NO. WOInC Oa:"L' C ESTIMATED COST y 00 TELEPHONE k7S
OWNER l' ADDRESS
v elw G
WATER HEATER
31. TYPE L'f I / N 4 'C' 32. MANUFACTURER
TANK SAFETY DEVICES
33. CAPACITY 37. TEMPERATURE RELIEF VALVE
34. TEST PRESSURE 38. MANUFACTURER_
35. WORKING PRESSURE 39. PRESSURE RELIEF VALVE
36. TYPE 40. MANUFACTURER
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF THIS PROPERTY
AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
CD962 DATE SIGNATURE OF APPLICANT
PERMIT
Application For 6463 6063
DEPARTMENT DECISION
Cd EnHeating PermitOO
3E APPLICATION Is HEREBY:
DEPARTMENT OF LICENSES AND INSPECTIONS
N Ck APPROVED DISAPPROVED
TOWN OF SOUTH WINDSOR
0
r.
C " 1 2119 1clams Thomas R D1 A Sri aDATICCHiEJF-FNPftTbR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL WO
e»
o a 1. LOCATION OF JOB
O
5 CAN y LL RO
Cd0
O NO STREET
v 2—rn
LOT NO. FLOOR APT. NO.O O
4) 1%
lV
79
j O
A E 2. OWNER
Cd
Ce O
3 s. ADDRESS
4.PHONE 3 0 9
S. APPLICANT
ogo
a. ADDRESS
Cd
7.PHONE
S. LICENSE NO. Homeowner
a
C w B. EXPIRATION DATE OF LICENSEc
O 10. ESTIMATED COST s 000
w
E 11. IS THIS A CONTRACT COSTT YES No
12. FEE ENCLOSED s UA rm it 13901
x
rA W
13. TYPE OF BUILDING:
an rn
O >;RESIDENTIAL COMMERCIAL
C
14. TYPE OF JOB: N e INDUSTRIAL3
RIGINAL ALTERATIONINSTALLATIONADDITION
REPAIR
I
APPLICATION FOR HEATING PERMIT (Continued tr m Revene side)
11. LOCATION OF JOB
r L dN Z
NO. f STREET FLOOR AFT.NO.
12. TYPE OF INSTALLATION: U OIL BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR MISCELLANEOUS
IDENTIFYSIZESIZE
13.
SIZE
OF TANK 2 2 OFCTANKN C O OF FILL 2 ,/ OF VENT
s f
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND N0. r`'W ENp-r y'AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO. B.T.U. OR SQ. NI'LET B.T.U. OR SQ. FT. GROSS FIRING RATE
FLOORS TO BE HEATE 3 NEW OR OLD BUILDING -VC INSULATED - YES OR NO CS
Iq 3IP INSULATIONTYKEOFWALLINSULATIONROOFORCEILING_
AVG. SYSTEM WATER TEMP. 190 B.T.U./SQ. FT./HR. EMISSION J
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE C?o J' FAHRENHEIT
MAKE OF RADIATION: BASEBOARD, COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U. f 4 Lo A,)
DESCRIPTION OF WORK e15. TO BE DONE:
16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
ROOM slzE wlNDowa AREA - SQUARE FEET e.r.u. e.T.u.o DISTRIBUTION INSTALLED
AND DOORS VOLUME TOTAL TOTAL
ROOM NO'GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED -J
r LL REGISTER
F
4
TYPE AND SIZE RAD. OR LEADERLWNANDEINFILT.) TEMP. TO
O F O SQ. FT.
SIZE < WAIL
f'LSO DIFF. F F m N FREE AREA
75<
TOTALS
A. HEAT LOSS FROM BUILDING B.T.U./HR.
B. DOMESTIC HOT WATER DEMAND B.T.U./HR.
C. PIPING, OTHER THAN NORMAL B.T.U./HR.
ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR
17. ELECTRICAL WORK BY: t Wo ej d
NAM[ ADDRESS
SUBCONTRACTORS AND
18. THEIR TRADES
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL
BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
APPLICATION TO BE COMPLETELY FILLED IN.
J I 7
DATE SIGNATURE OF APPLICANT
B= R CALCULATION SHEET 1503 (Modern Method) Copyright 1977 by The Hydr nits Institut
OWNER ^ 21 ADDRESS DESIGN TEMPERATURE DIFFERENCEJf6Ft. DATE
C L.A COL.B COL.C COL.D COL.E COL.F
M
COL.G
rQ1ROOMIt t i A-t e P` ^
L W H L W H L W H L W H L W Design Water Temp.O
J2ROOMDIMENSIONS,FT. V 9. .Z / Z l J Z., G7 BTUH per Foot of
3 LENGTH EXPOSED WALLS, FT. i! Z Radlati n Selected
4 WINDOW AND OUTSIDE DOOR AREA Z
BTUH STUN BTUH BTUH BTUH
5 WALL CONSTRUCTION
Tab) 9,Line 3 x H) e(l. v Q-Lr11 TOTALS RADIATION
6 TYPE OF GLASS FROM LINE 12 SELECTED
Bottom f table used for Line 5)
7 CEILING CONSTRUCTION C J
Table 9,L x W) 00 ly 6(fy v 0--'2 2!S-x> )e G>-
g FLOOR CONSTRUCTIONt
Tabl 9,L x W r Lin. Ft.) E 1'U
9 COLD PARTITION CONSTRUCTION P 2Ica Ll
Tabl 9,L x H)
10 e 1 Wall(With Openings) 03 eD '
E z4 q J2Walls(With Openings)X r0 Y CJ k I/v 1
3 Walls(With Openings)or Ent.Hall 40-0
11 TOTAL BTUH AT 70F TEMP. DIFFERENCE* K2 cro a v &-a
12 TOTAL BTUH AT DESIGN TEMP. DIFFERENCE K
crL? O c7 c ti
L
COL.A COLS COL.H COL.I COL.J COL.K COL.L TOTAL BTUH TOTAL
1 ROOM
Ir 0-e 'Z„ ty
F BUILDING RADIATION
AT SELECTED
O H L W H L W H L W H L W H L W DESIGN TEMP.°
DIFFERENCE
2 ROOM DIMENSIONS,FT. V
31 LENGTH EXPOSED WALLS,FT. Q 1 L--
4 WINDOW AND OUTSIDE DOOR AREA U.
HBTUHBTUHBTU BTUH BTUH
5 WALL CONSTRUCTION INCREASE BATHROOM
Table 9,Line 3 x H) eV L f -...y TOTAL 20%
6 TYPE OF GLASS
Gott m of table used for Line 5) x fJ' V r O"1t a
7 CE41-ING CONSTRUCTION
t
GROUND
CONCRETE FLOOR ON
GROUND OR FILL AT
Tab) 9,L x W) 4 GRADE LEVEL,USE LINEAR
S FLOOR CONSTRUCTION1 FEET OF EXPOSED EDGE
Table 9,L x W r Lin.Ft) v d U -
9 COLD PARTITION CONSTRUCTION
Tabs 9,L x W
10 _ 1 Well(With Openings)
WOO
a 2 Wells(WM Openings) X
J
3 Walls(With Op nings) r Ent Hill b
11 TOTAL BTUH AT 7OF TEMP.DIFFERENCE'
12 TOTAL BTUH AT DESIGN TEMP. DIFFERENCE tj-U
FORM 1503
ESTIMATE
QUANTITY ITEM AMOUNT
Boiler No. Net I=B=R Rating or Net SBI Rating*
Oil or Gas Burner or Stoker, with Controls
Oil Tank, Pipe and Fittings
Combustion Chamber or Stoker Hearth
Pump
Thermostat
Low Limit Control
Reverse Control
Extra Controls
Draft Regulator
How Control Valve
Pressure Reducing Valve
Relief Valve
Air Cushion Tank
Domestic Water Heater and Tank
Mixing Valve
Pipe, Valves, Fittings, Hangers
Pie Covering
Heating Units (Radiators, Baseboards, Convectors)
Radiator Enclosures
Sets — Radiator Brackets
Radiator Valves
Radiator Union Elbows
Radiator Air Valves
Main Air Vents
Floor and Ceiling Plates
Smoke Pipe
Foundation
Electric Wiring
Pounds -- Asbestos Corrent
Paint
Freight and Cartage
Labor
Incidentals
Total Cost
Overhead
Profit
Bid
Net I=B=R Rating r Net SBI Rating f B Her sh uld equal r exceed the
total heat I ss f the h use plus pr per all wanc f r domestic h t water
Application For
PERMIT #
4j DEPARTMENT DECISION
Cd
0 Heating Permit
3 APPLICATION IS HEREBY:
0 w DEPARTMENT OF LICENSES-AND INSPECTIONS
N APPROVED DISAPPROVED
TOWN OF SOUTH WINDSOR
O cd0
00 O DATE CHIEF INSPECTOR
O APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BELOW
B]
p 79 1. LOCATION OF JOB
O
s. '~
vNO. STREET
cn
LOT NO. FLOOR APT. NO.O O
LV
her
O
E 2. OWNER I?fc,,k Age ti..a .e S
O
beO S. ADDRESS3
U Lil G x C PHONEo Cd
S. APPUCANT /C 9 S
eri as
l
6. ADDRESS 3 a L ie;,
7',e 7.PHONE l
11. LICENSE NO. 3 6.2— i_Jr r
Q
p w s. EXPIRATION DATE OF LICENSE
00 10. ESTIMATED COST S d
N
E bq 11. IS THIS A CONTRACT COS"lz_YES no
12. FEE ENCLOSED
k
a)
13. TYPE OF BUILDING:CA
O A RESIDENTIAL COMMERCIAL
acei 3 14. TYPE OF J08: El INDUSTRIAL
ORIGINAL ALTERATIONElINSTALLATIONADDITION
REPAIR
APPLICATION FOR HEATING PERMIT (Continued from Reverse Side)
11. LOCATION OF JOB a -QY C )4r 1( 40 Ya-
NO. STREET FLOOR APT. NO.
12. TYPE OF INSTALLATION: OIL BURNER Cl ELECTRIC VENTILATION SPRINKLER
ElGAS BURNER STACK INCINERATOR MISCELLANEOUS Alle C--d Z CDs-r
IDENTIFY
SIZE LOCATION SIZE SIZE
13. OF TANK OF TANK OF FILL OF VENT
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO. B.T.U. OR SQ. FT. NET B.T.U. OR SQ. FT. GROSS FIRING RATE
FLOORS TO BE HEATED NEW OR OLD BUILDING INSULATED — YES OR NO
TYPE OF WALL INSULATION ROOF OR CEILING INSULATION
AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE FAHRENHEIT
MAKE OF RADIATION: BASEBOARD, COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SO.
FT. OR B.T.U.
DESCRIPTION OF WORK
15. TO BE DONE: y S fSF J l-roq Y4-1 JE Cry el ?~'w Wi Sy'.Q bA
e-io f22 IyC CLA 6 3 o Can ca-n Cea Pc" z4 Q A s o 3 A 61-ZE 1ycx"
16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS).
ROOM slzE wlNDowa AREA - SQUARE FEET B.T.U. O.T.U. < DISTRIBUTION INSTALLED
AND DOORS VOLUME TOTAL TOTAL
NO.
LL
ROOM Ggpgg GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED j LL RAD. REGISTER
L W M AND IK INFILT.) TEMP. TO O f IL TYPE AND SIZE
aQ FT.
OR LEADER
SIZE < WALL to DIFF. F F O N FREE AREA
TOTALS
A. HEAT LOSS FROM BUILDING B.T.U./HR.
B. DOMESTIC HOT WATER DEMAND B.T.U./HR.
C. PIPING, OTHER THAN NORMAL B.T.U./HR.
ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR
17. ELECTRICAL WORK BY:
NAM[ ADDRESS
SUBCONTRACTORS AND
18. THEIR TRADES
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL
BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
APPLICATION TO BE COMPLETELY FILLED IN. l0-5 zoDATE SIGNA YW APPLICANT
LABORATORY REPORT
Standard Water Analysts
Date: 12161 s
Client: 106 r'cef C love.+
CT
RE:
Sampling Location YC,wus,
Results: 2-,/-yy
pH
Alkalinity mg/l o
Hardness mg/l 4q
Chloride mg/l a1'
Color Units ]qj ,Y a
Odor O/
Turbidity FTU a,3
Nitrate as N mg/l q- 3?
Nitrite as N mg/l Lo, OOS"
Ammonia as N mg/l
Detergents mg/l Lo,
Iron mg/l 40. 1
Coliform o r no rrml
Manganese mg/l Z o ,per'
Sodium mg/1 f e l O
e— = (,e.&S
or,\ 0-ccep4ccbk,
suppl) sc r --(J- \-
ce\oj rA
f RISWOLD & FUSS ENVR. LAB.
X1411.,Z e-
LABORATORY DIRECTOR
P. H. 0441