HomeMy WebLinkAbout101 WYNDEMERE CT BLDG 1 DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
B(du. Permit It
�k�9.
644-2511 ext. 230
Date Building Inspect r
Application must be printed or typed
FEE SCHEDULE / Location of Job:
[Tenant
)t I.t��Nde•�ert Gam•
$0-$1,000=$15.00 eet No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Designation Apt. No.
APPLICANTc�/GwS �O r
APPLICANT ADDRESS /.3P 4 ALk f C
APPLICANT PHONE# ���� 5—:�- 8
oW N s F,q OWNER z tom►,vl*
OWNER 27SS IOC
�v Q �rn d l'cvL , G 7
Oa OWNER PHONE y3 2
C = ESTIMATED COST$ ?l' act/
IS THIS A CONTRACT COST? _Yes "R-o
FEE ENCLOSED$ 45-• G U
1��5 O�� TYPE OF JOB: �5��P
R C 1--New Installation
_Alteration/Addition/Repair
G31
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
El-REATING ❑RESIDENTIAL
❑A/C 0 COMMERCIAL
0 VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC 0 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 HE ING EQUIPMENT(INCLUDING M &M )DEL NO.)�� /
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH)
TYPE OF FUEL
ROIL--GPM /.1rOIL TANK LOCATION :O INSIDE❑ OUTSIDE CAPACITY
❑ GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW
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 lZC lle. ' -& tX,�+^'
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.
-:?'0 3�> Q 2-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT 5� f / DATE `7 / 9
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: o pU ps
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
4--� 644-2511 ext. 230 Bldg. Permit#
Date Building Insp ctor
Application must be printed or typed
FEE SCHEDULE �j/ / Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C c /J O r ( t�0 I
APPLICANT ADDRESS 13 lc' ,- s'/- -
Ati,, 1d1Sc%n _ ,- .- t':�;6C 7y�
APPLICANT PHONE# // 02 G
p w N S F,q OWNER S Q l( Gl /W,4 4116 k ,
OWNER RESS le�6
OWNER PHONE ����� — �� 77
C = ESTIMATED COST$
b
IS THIS A CONTRACT COST? _Yes vRo
FEE ENCLOSED$
1��5 O �TYPE OF JOB: � 33�)
R C 4e�w Installation
Alteration/Addition/Repair ®l -
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
EATING ❑RESIDENTIAL
❑A/C ❑COMMERCIAL
❑VENTILATION ❑ INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
alFrYDRONIC ❑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 HE A/ TING EQ PMENT( CLUD G MAKE&MODEL O.l
/3OC /t G� l/ 74-
iit t ljt/c csc Gd*!C-t �t� e/
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH)
TYPE OFF�L
9 OIL-GPM ��U OIL TANK LOCATION :O INSIDE❑ OUTSIDE CAPACITY
❑GAS-INPUT LPG TANK CAPACITY ELECTRIC-KW
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 � /!7C i
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.
3703? ,�? 2 S-� C'`T- .
CONTRACTORS LICENSE NO. E E
3 GTA
SIGNATURE OF APPLICANT DATE U