HomeMy WebLinkAbout20 Abar Lane (8)DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
PEPEG ITBUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230
Bldg.Permit#
of Jam- 2766 y
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE
F;Tenant
f H-Location of Job:
0-$1,000=$13.00 Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof nation Apt.No.
APPLICANT
APPLICANT ADDRESS
cj,dA 1
APPLICANT PHONE#
SOW N St OWNER c:v-t
OWffNER/ADDRESS 7 0
T ` Ey Cyr 7
OWNER PHONE j4i.Y—
V ESTIMATED COST$ o 6 o 0
IS THIS A CONTRACT COST? es, No
FEE ENCLOSED$
OR CO
TYPE OF JOB:
0 Original Installation
lteration/Addition/Repair Revised 8/99
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF BUILDING:
Q-16EATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
S3'FAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC WARM AIR UNIT RADIANT HEATER
UEXISTINGRADIATIONADDITIONALRADIATIONTOTALRADIATION /
DESIGN TEMP. OUTSIDE_n OF INSIDE 4?0 OF DIFFERENCE F
TOTAL HEAT LOSS(BTUH) F(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
6 rOL'fu
W"l C.; •t c l' L NC .S',•.! •G n /J/1 S L ra S'G bTu 4 F-(t,
GROSS HEATING CAPACITY(INPUT-BTUH) * CtXRET RATING(OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM GAS-INPUT q6) ydv 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
C_ V,,°aer q-yycK
TA CTNDERSIGNED 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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT/ i j ii:%4, DATE l U'