HomeMy WebLinkAbout26 Castlewood Drive (6)i
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Application is hereby:TOWN OF SOUTH WINDSOR
PERMIT#<:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
Location of Job:FEE SCHEDULE h—
0=$1,000=$13.00 Street Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT —= e %0, C
APPLICANT ADDRESS O 1 } 1 /r (lJtj
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APPLICANT PHONE#—_1- Z\ ITS
OWN s t OWNER 1 X
OWNER ADDRESS
j C
r OWNER PHONE
O MID ET OSIMATEDCOST$ C7 C7 C
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IS THIS A CONTRACT COST?
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3 Yes 0 No
Q FEE ENCLOSED$ S12)C\
TYPE OF JOB:OR-CO Aoriginal Installation
O Alteration/Addition/Repair Revised 8/99
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APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SY EM: TYPE OFFBBLDING:
EATING SIDENTIAL
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.)
yJtxi mN- Lam\, c C - ;s
GROSS HEATING CAPACITY(INPUT-BTUH) i y NET RATING(OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM GAS-INPUT ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
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.
C", w S -
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT S it DATE
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