HomeMy WebLinkAbout160 Birch Hill Drive (9)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT RN, #4
Application is hereby. TOWN of SOUTH WINDSOR
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BUILDING DEPARTMENT Blda Pe it
APPROVE 1540 SULLIVAN AVENUE
CfR, 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location ofjob
0 Ae -err(w (*#a)
Street No. Street Lot No.FFEE SCHEDULE
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000
or any fraction thereof
OWNER iLa
ADDRESS
OWNERS PHONE#
APPLICANT
0t0 N 8,e4
ADDRESS
4(
K.
ESTIMATED COST $ 2L
IS THIS A CONTRACT COST?
YES NO
4j a;2FEEENCLOSED $
OR-CQ TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Raised 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.
HYDRONIC— WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION 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 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 WO
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WO
2-s- Z 4, ,
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STATE LICENSE-NO. NAME&TYPE SIG ATURE F APPLICANT
PHONE NO Ul ,f3 DATE
INSPECTOR JFP DATE i TIME Oak
LOCATION
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INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
PLUMBING:
HVAC:14(Ca
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OTHER:
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