HomeMy WebLinkAbout107 WYNDEMERE CT BLDG 1 DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Applic h4reby BUILDING DEPARTMENT ��g
APP OVER 1540 SULLIVAN AVENUE
3` 644-2511 ext. 230 Bldg. Permit#
Date BleAing Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000 _
or any fraction thereof Tenant Designation Apt. No.
APPLICANTrt�,✓S p• / �Q',
APPLICANT ADDRESS /3 tr dye S
APPLICANT PHONE# Z c(7
SOW N SFq OWNER STD' It r
OWNER RESS
Cif J` _
O ,o OWNER PHONE ��� O� T y
C ESTIMATED COST$ ,/000 G
IS THIS A CONTRACT COST? _Yes 4—*No
FEE ENCLOSED$ yS- G O
1� TYPE OF JOO
�SOR'COS New Installation
_Alteration/Addition/Repair �
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
G HntATING 3-I6SIDENTIAL
❑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 INC UDING M4KE&MODEL NO.)
4C7 G k a��Gr� a-f eiL �(
'-wDE -Sv e
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH)
TYPE OFF '1
LY ��OIL-�PM /V OIL TANK LOCATION :❑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
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.
-?032 69Z S
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLIC ATE /