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PERMIT #
Application For
DEPARTMENT DECISION 4000
4222 Heating Permit
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3 APPLICATION Is HEREBY:DEPARTMENT OF LICENSES AND INSPECTIONS
X0 APPROVED DISAPPROVED
TOWN OF SOUTH WINDSOR
Cd
a 12-4-72
00 G> DATE CHIEF INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BELOW
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C 1. LOCATION OF JOB
Cd r. NO. STREET
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cs v
y LOT NO. FLOOR APT. NO.
0 ON
0 2. OWNER1.4
Cd
0
a. ADDRESS
3
PHONE
APPLICANT
c 00 B. ADDRESS 4 Sj D/--174---f
1944 7.PHONE
v B. LICENSE NO. 2'
C w B. EXPIRATION DATE OF LICENSE JA
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10. ESTIMATED COST s AZ C
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11. IS THIS A CONTRACT COSTf fS NO
12. FEE ENCLOSED s Permit #7773
d 13. TYPE OF BUILDING
00 L REStBENT1AL COMMERCIAL
41 a> 14. TYPE OF JO INDUSTRIAL
INSTG.ALLATION ADDITIONON
REPAIR
APPLICATION FOR HEATING PERMIT (Continued it >m R verse Side)
LOCATION OF JOB J
NO. STREET FLOOR AFT.NO.
12. TYPE OF INSTALLATION: OIL BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR MISCELLANEOUS
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
PL;R "OILER OR FURNACE MAKE AND NO.Foo —1 y B.T.U. OR SQ. FT. NET/ B.T.U. OR SO. FT. GROSS FIRING RAT ' S
FLOORS TO BE HEATED NEW OR OLD BUILDING 7`F k-' INSULATED — YES OR NO— PS
TYPE OF WALL INSULATION ROOF OR CEILING INSULATION
AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE 7!-- '??iA e FAHRENHEIT
MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SO.
FT. OR B.T.U. R Q V 13 le3i—S--e 13` y/}fZ D— D 13 Z—V-
DESCRIPTION OF WORK ` S Sis. TO BE DONE: h
18. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS).
ROOM SIZE AND DOOR!
AREA - SQUARE FEET votu E
E.T.U. B.T.U. g f DISTRIBUTION INSTALLED
TOTAL TOTAL pl LL
ROOM NO'GROSS OLA!! NET WALL ClI LINO FLOOR CU.FT. AT 70•F CORRlCTED j RAD.
REGISTER
L M N AND a TEMP. TO t f TYPE AND SIZE OR LEADER
SIZE < WALL
R'Lio INFILT.) DIFF. F F m» O. FT. 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:
NAME 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. //_
T DATL S16NATUR[ OF APPLICANT^