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HomeMy WebLinkAbout12 GARDENIA LN LOT 12 APPLICATION FOR ELECTRICAL PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT APPR 1540 SULLIVAN AVENUE 1 O_bib 644-2511 ext. 230 Bldg:Permit# Date Building I r Application mast be printed or typed FEE SCHEDULE Location of Job: $6-$I,000 $15.00 ( 2 G A R D E-N 1 L.AN E" Over$1,000= Street No. Street Lot No. $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANTI _ �Ol-}-� � Las-R©C-)4 F— lr-L1` APPLICANT ADDRESS SQ X 3 S O SrzoApi3 Roo c— c fo APPLICANT'S PHONE# <oO g 30- 0-S 6 OWNER 10R &0 I L D L R £4< OWNER ADDRESS �7 G, L-y PA U, 4ST C . ES C- O O F OWNER PHONE a ro 2 C ESTIMATED COST$ +� U IS THIS A CONTRACT COST? Yes No FEE ENCLOSED$ (� ° TYPE OF JOB: \ZU P-�6 OR'CoNew Installation Alteration/Addition/Repair �0 Revised 03/05/10 APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A / BUILDING PERMIT APPLICATION? El YES ❑ NO & RESIDENTIAL CURRENT USE AND OCCUPANCY ❑ BUSINESS ❑. ASSEMBLY FUTURE USE AND OCCUPANCY ❑ EDUCATIONAL ❑ INSTITUTIONAL ENGINEER'S NAME PHONE ❑ FACTORY ❑ STORAGE ADDRESS O GARAGE O MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? ❑ YES ❑ NO NUMBERS OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS ' NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK R�P� ALL- DE\JlC�S , L 164T P( xTrL)(2� l N IEN 7-1'R E N E V 1S 4/12S \/ D-ED i c.ATED CI RCU i T FOR M rCRVUVA y E THE UNDERSIGNED HEARBY 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 PERFOR- MANCE OF SUCH WORK �-`- CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANTLJ-xqIL DATE DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT ��Oy A _PROVED 1540 SULLIVAN AVENUE / 644-2511 EXT 230 Bldg.Paint# _/ (Date) ( ilding Inspector) Application must be printed or typed FEE SCHEDULE � h l Q t t&5or CT $0-$1,000=$15.00 StreetSN_o. Street Lot No. Over$1,000- $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT f) - lkfC Ul APPLICANT ADDRESS -15 [GW � C -701 -d, "T 0(cO APPLICANT PHONE# ? OWN $£ OWNER�l 9T'_.'�1 C� Y 5' OWNER ADDRESS %-� V(,QQ- �S CT 0(c>6210 rQ • ,yy, . r 0 +y, OWNER PHONE C ESTIMATED COST $ ` U IS THIS A CONTRACT COST? YES NO FEE ENCLOSED$ s TYPE OF JOB: �� SUR•Co New Installation Alteration/Addition Repair Revised 12/22/11 APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) E DE BUILDING IS THIS APPLICATION ASSOCIATED WITH A RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑ NO ❑ BUSINESS CURRENT USE AND OCCUPANCY ❑ ASS&BLY ❑ MERCANTILE ❑ EDUCATIONAL FUTURE USE AND OCCUPANCY ❑ FACTORY ❑ STORAGE ENGINEER'S NAME ` PHONE ❑ GARAGE❑ MIXED USE ADDRESS G,(Other please specify) CITY��S " �Q:tb Sat' STATE ZIP TYPE OF INSTALLATION SIZE OF MAIN DRAIN NO. OF TOILETS, Q STYLE NO. URINALS STYLE NO. OF BATHTUBS NO. OF SHOWERS NO. OF LAVATORIES NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE AREA OF ROOF NO. OF CATCH BASINS NO.OF FLOOR DRAINS NO.OF OTHER FIXTURES KIND ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW ❑ YES ❑ NO SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR SIZE OF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER WATER HEATER: TYPE MANUFACTURER DESCRIPTION OF WORK Ar 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. C:2`S 7 30' ? 1 CONTRACTORS LICENSE NO. TYPE l STATE SIGNATURE OF APPLICANT 1 ,/�„J.--r'"`J DATE !`ZL I(k) BUILDING PERMIT ISO_ ' STATE OF CONNEC77CUT WORKERS'OOMPENSATION COMMISSION ' Building Permit Affidavit for Property Ovmers or Sole Proprietors (Conn.Gen..Stale§31286b) Property located at In the town of 7 W i rylzr Name of building permit applicant Please check one: 1. I am the owner of the above property. I am the sole-proprietor of a business. 2A.Name of business —:---2B.Federal Employer.Identification Number QqD ...............................................................................:...................:.......:..e.«... Pursuant to§3I 286b,"a-property awaw or sole proprietor[who]intends to act as a general contractor or principal employer"may provide either a catiGcate of workers'compensation. insurance or.a"sworn notarized affdi&..stating that he will require proof of workers' compensation insurance for all thole employers on the job site in accordance with this chapter." Please eclt AMC. I do not iatend to act as a general contractor or principal employer. [Sign and stop here] Signature of applicant 2.._I int d to no as-a general.contractor or principal employer.Applicant must either FKo"a Oord&ate of workeW compensation insurance or sign the affidavit bblow. .................................................:......................:....................................:.«.:. At Wh" I hereby swear andmeat that I will require,proof of merlons'compensation insa MCG for every contractotx subco ot;or odw wwkw before he/she aagsges in work on the above property is accordance with tho'WCdoets'CamI,pin don Act(Chapttef5m. I understand that.prusuaat to§31475.C.f3:S.,officta of a corporation and partners in a partnership ropy clod to be=dudod ftgm coverage by filing a waiver With tho.appropriabe District Office,;and that a sole proprictoc of a business is not rogairod to have.Cor"up unless he files his intent to accept Coverage, Signahn of applicant Subscribed and sworn to before me this day of ;200 . (Notary Publie!Commissioner of the Superior Court) S ' O Illloll ` 14%, I v 1 I3� I y — t, tv R��J V _ 3E i3� / 10 10Ell Q� X. — �SnO'� f _i '' T 4� Lol 4g NOTES: 1. REFERENCE IS MADE TO THE FOLLOWING MAPS: PEACHBROOKE, ZONE DISTRICT DRZ, APPLICANT BROM BUILDERS, INC., 207 WEST TOWN ST., NORWICH, CONNECTICUT, (TELEPHONE: (203) 889-7106) PROPERTY OF NORMAN P. PRIEST, SULLIVAN ANVENUE - CONN. ROUTE 194, SOUTH WINDSOR, CONNECTICUT, DATE: q—q-7J MARCH 13, 1991, REVISED THRU 1/30191, SCALE: (AS SHOWN). SHEETS 1 THRU 15 OF 15, ____ __ __ _____________ PREPARED BY DAVID L. STEIN, LS., CERTIFIED BY DAVID L. STEIN, LS AND THOMAS THOMAS A. STEVENS, P.E. & L.S. 10203 STEVENS, PE & LS. I HEREBY DECLARE THAT THIS MAP IS SUBSTANTIALLY REVISED PLOT PLAN . LEGEND CORRECT. THIS MAP AND SURVEY WERE PREPARED IN ACCORDANCE WITH THE STANDARDS OF A CLASS A-2 LOT # 12 � PROP. CONTOUR SURVEY AS DEFINED IN THE "RECOMMENDED STANDARDS \ EXIST. CONTOUR FOR SURVEYS AND MAPS IN THE STATE OF CONNECTICUT" ® PROP. ELEVATION PREPARED AND ADOPTED BY THE CONNECTICUT ASSOC. PEACHBROOKE / 00.0 EXIST. ELEVATION OF D SU EYO INPt, ON SEPTEMBER 13, 9$4. ——S—— 6" SANITARY _ l ( /-� I PREPARED FOR --W-- WATER LINE , --F-- 4" FOOTING DRAIN AVID L. STEI ', LS 15461 DA BROM BUILDERS INC. 207 West TOWfl St. Norwich CT DAVID L. STEIN', LAND SURVEYOR P.O. BOY 1097, WESTBROOK, Ct - 399-5269. 889-7106 SOUTH WINDSOR, CT SCALE: 1" = 20' "EMBa1z- ".S (01191 I I i SEP 1 U 1991 South Windsor BUILDING DEPARTMENT f t ivfrl OF ZONING COMPL1ANt::. -.Cgp3sed buildfng(4 usels) andlor structure,l ,s sbcwn or, this plan app, earls) to be in ;,—,jfo;mance with current South Wirdsr3 ;ufations. Varian and special exception, may apply Gate rt d — t t'''.5 tIin 1 sV r.� oning Enforcement Officer . ;r l�e N,.,�j,rJ L,l—n^ Cr slt"r.: t J 1.t z Geri or-. Xf ^ rr •1 a^rd-,-nt+ •.tom •-ct In -- p .:v t^ I�ws am1 'h rr . ..t r and tl/n,I r u.•n^c f r n �If C ` I1 r�ld`/:171t'(rt I' i•1`.• f. n.^`'I 1 ,1 crC.nancrs r<„u l Lt,n; LU;I-,,t Appravcd These t.l.J �.Ln ti �.r11r.,; I�sLsa�C.or CI,_r. i Nr _ / I iU11 .Ole << e �z5: Q �' N / 13Co �� D Ll� "'00' v 1A _ L _t TV / 4 r C; • u fro o °- - I a-ems ,,.1.. �.? 11� -4- .01 / ► o N 9Z ��V - 1 -- 12 0' �jIr Aj 9: S- i a- r 'A 14' owl r4� _o� � u 50 0 fv Pv""A' NOTES: 1. REFERENCE IS MADE TO THE FOLLOWING MAPS: PEACHBROOKE, ZONE DISTRICT DRZ, APPLICANT BROM BUILDERS, INC., 207 WEST TOWN ST., NORWICH, CONNECTICUT, (TELEPHONE: (203) 889-7106) PROPERTY OF NORMAN P. PRIEST, SULLIVAN ANVENUE - CONN. ROUTE 194, SOUTH WINDSOR, CONNECTICUT, DATE: MARCH 13, 1991, REVISED THRU 1130/91, SCALE: (AS SHOWN), SHEETS 1 THRU 15 OF 15, ----------------------- PREPARED BY DAVID L. STEIN, LS., CERTIFIED BY DAVID L. STEIN, LS AND THOMAS THOMAS A. STEVENS, P.E. & L.S. 10203 STEVENS, PE & LS. I HEREBY DECLARE THAT THIS MAP IS SUBSTANTIALLY REVISED + PLOT PLAN . LEGEND CORRECT. THIS MAP AND SURVEY WERE PREPARED IN 7,92119 I 77 ACCORDANCE WITH THE STANDARDS OF A CLASS A-2 OT '�i ��— PROP. CONTOUR SURVEY AS DEFINED IN THE -RECOMMENDED STANDARDS L M d # O N L ^ EXIST. CONTOUR FOR SURVEYS AND MAPS IN THE STATE OF CONNECTICUT- kill, ELEVATION PREPARED AND ADOPTED BY THE CONNECTICUT ASSOC. P EA C H B R 00 K E 00.0 EXIST. ELEVATION F L NO SUR�V2YOAS, 1 ON SEPTEMBER 13, 1984. p --S-- 6" SANITARY PREPARED FOR --W-- WATER LINE --F-- 4" FOOTING DRAIN L. STEIN, LS IS161 DA BROM BUILDERS INC. 2 DAVID L. STEIN, LAND SURVEYOR 07 West Town St. Norwich CT P.O. BOX 1097, WESTBROOK, Ct - 399-5269. 889-7106 SOUTH WINDSOR, CT SCALE: 1" = 20' DATE:SL=P-rr--M$ER- 3 1OnI 1 I SEP 1 U 1991 South Windsor BUILDING DEPARTMENT I 7 ' ICATION OF ZONING COVOPLIANCE Cjpjsed building(s), use(s) and/or structure;) T £f r i t"'f " s shown on this plan appear(s) to be ire £..,ctc of cn l.� at ,.Gnfxrnance with current South E"lind-�r_.; —��Z— �.z t� L \�__ . ula-ions. Variances and special exception; ,nay apply. t,C rzY Gate M LCIC(.I Zonl Enforcement Officer. W n,1lr,unWily A �roveA T.`es� f.LJ s,. GuralnE; Ins�.Qc'.•� JyCwM 7 Itv111 c,tr otJ IV'YuATER co >✓q�tc t�8 I.I T -I IJ 1r i T I L-I T 1=A S A N E Plr 4��� 12 J: l-- i< y 2n y fl1 71 r of I J 4,0/ ' � •!L;' i�3.70 � � mil``• �� � � �� � SJ 1 i 14 If _ r _ ^ I/ / �O 0 A-j--BUILT L>�G>� N� X(l 32.5� SYOT t✓l-5 1• "5 -- 5A N 1-rAlz'>' s>;vu�- GOIJTOLJ FZ e - �LTK-1G �iT �KYIG1= V --DeGIG NOTES: A /6 P�� '1 FILDI=�S� IE`IG. 1. REFERENCE IS MADE TO THE FOLLOWING MAPS: PEACHBROOKE. ZONE DISTRICT DRZ, APPLICANT BROM BUILDERS. INC., 207 WEST TOWN ST- NORWICH, CONNECTICUT, (TELEPHONE: (203) 889-7106) PROPERTY OF NORMAN P PRIEST, SULLIVAN ANVENUE - CONN. ROUTE 194. SOUTH WINDSOR. CONNECTICUT, DATE: MARCH 13. 1991. REVISED THRU 1/30191. SCALE: (AS SHOWN), SHEETS 1 THRU 15 OF 15, PREPARED BY DAVID L. STEIN, LS., CERTIFIED BY DAVID L. STEIN, LS AND THOMAS STEVENS, PE & LS. I HEREBY DECLARE THAT THIS MAP IS SUBSTANTIALLY REVISED PLOT PLAN LEGEND CORRECT. THIS MAP AND SURVEY WERE PREPARED IN I i3 ACCORDANCE WITH THE STANDARDS OF A CLASS A-2 LOT " I z 1 1�I��) ___ PROP. CONTOUR SURVEY AS DEFINED IN THE "RECOMMENDED STANDARDS EXIST. CONTOUR FOR SURVEYS AND MAPS IN THE STATE OF CONNECTICUT' PROP. ELEVATION AS PREPARED AND ADOPTED BY THE CONNECTICUT ASSOC. 00.0 EXIST. ELEVATION D SIKVEYORS INC ON SEPTEMBER 13, 1984. P E A C H B R O O K E - -S- - 6" SANITARY l/ � PREPARED FOR --W- - WATER LINE 111 I �Ff' t.ti 15461 - -F - - 4" FOOTING DRAIN BROM BUILDERS INC. I t . �7'1:1�. I \%,n SLLIZV1,AOR 207 West Town St. Norwich CT (�•��, r1u\ 109-. \t E,,,FI i200K, 0 - 399-5269 889-7106 SOUTH WINDSOR, CT SCALE: V, - 20 DATE:Sr--V rGMBEP` rJAN 15 1992 South Windsor 13UILDING DEPARTMENT TO THE GL':L�d1iG DC?T. To'.::•1 ;- This certified that this plan Pt topics of the proposed bui,,. erected at ^ t 1—tner with amendmrrt L ` lilcd with Alin and 1 aer ;%ildlog and state I1ws 1- ��d by the Building (, i this application and fin- Prrmlt. S UJned his plan is approved subject to thv eon"ili, .:rd rs and ordinances regulating bulling c„mrlwd with. Conditionally Approved Theses filed a1.4 Building Inspeetoe 9 Ckrk 'p 6 TOMAii or Soul" �,y �C� strewRpm 09P DAIM 0 �JN1'K+A EIP- Go E-t,�i>Gl1EIJ-1- i 01 tI 1 - �✓/ am*.. dO -a L s"}\)may% d �44.4f-'•{,� ��� ,z / d li / q-S / �O 0 -- ------------ A,--V3 u 1 (Z 1.3� —�1�--lt�•N`� (U� _'� — yc.t.�T�. 7C.i-V IG1: V. G O IJ-"f0 U FZ — 7E5 V -'DeGFG NOTES: 1. REFERENCE IS MADE TO THE FOLLOWING MAPS. PEACHBROOKE, ZONE DISTRICT DRZ, APPLICANT BROM BUILDERS, INC., 207 WEST TOWN ST- NORWICH, CONNECTICUT, (TELEPHONE: (203) 889-7106) PROPERTY OF NORMAN P. PRIEST. SULLIVAN ANVENUE - CONN. ROUTE 194, SOUTH WINDSOR. CONNECTICUT, DATE: MARCH 13, 1991. REVISED THRU 1130191, SCALE: (AS SHOWN). SHEETS 1 THRU 15 OF 15, PREPARED BY DAVID L. STEIN, LS., CERTIFIED BY DAVID L. STEIN. LS AND THOMAS STEVENS. PE S LS. I HEREBY DECLARE THAT THIS MAP IS SUBSTANTIALLY REVISED PLOT PLAN LEGEND CORRECT. THIS MAP AND SURVEY WERE PREPARED IN I 13 �L� ACCORDANCE WITH THE STANDARDS OF A CLASS A-2 LOT " �I��) __� PROP.EXIST. CONTOUR CONTOUR SURVEY AS DEFINED IN THE "RECOMMENDED STANDARDS FOR �V�z l SURVEYS AND MAPS IN THE STATE OF CONNECTICUT" L VV.VI PROP. ELEVATION AS PREPARED AND ADOPTED BY THE CONNECTICUT ASSOC. 00.0 EXIST. ELEVATION D S YOBS I C OON SEPTEMBER 13, 1984 PEACHBROOKE - -S- - G" SANITARY � PREPARED FOR --W- - WATER LINE I in L. 11't,l\, 1.� Irani - -F - - 4" FOOTING DRAIN BROM BUILDERS INC. ►1\N III 1.. Si'l-l\, LAND SL'R%'I•;1'0R 207 West Town St. Norwich CT I',O. JIM 1097. WES7'BR00K, CI - 399-5269 889-7106 SOUTH WINDSOR. CT SCALE: 1" = 20' ' t . JAN 15 1992 South Windsor BUILDING DEPARTMENT TO T„E .L:T, thiseertitlA that this plan and sC�ctfic :i,�- topics of the proposed building or aR_rr.st,na vetted at (2 C,Gi t�r('ther with amendments stated is zp;)Ac FI- It,d with plan and I agree to co:rj!y with -_!I ,i.lding and state laws and s:fi :rC,ra .,s and by the Budding Dep,—tr,.•nt duri,'g y_ t t."is application and final issuance of F,In,it. S.-ned i t s [`:an is aF,:revcd sablret la thh t�+n2.b tom R+ cr.!,rs and or6immncc-s tryr:ll"ag " dcny t.t.r.i l•• c•,t:i�.�J' wish_ Cora;rsaua:°x. ALCwovtd TYa� 1ritd with ' �/� APPR OVED TOWM of sotmi wv aSOR ENdM4EE1"H6 DEPARTMENT DATES talOtt -- - Electric # APPLICATION FOR BUILDING PERMIT Plumbing# G HVAC# t EIAr�:Ie n ne Date: Sprinkler# Estimated Cost $ 2-cl- ,cx-) FINAL APPROVALS Permit Fee $ t}� Building COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit N ON REVERSE SIDE t Appr.forCO. ► SIG Total Fee TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ �7:1d3 The undersigned hereby applies to do work according to the following: Applicant 1 ( -, O Mar LocationofWork 1 2(::jCAv-,Jc --)ia LcZ-� LotNo. Applicant's Address 1 7 t{ I�y GICzI �� Tel # Town AACL-"Cl--LC S CC✓ Zip CA Lic.# H t C 06 2 Cl Gcio Owner ci S Architect Owner's Address Architect's Address Zip Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permit I 0 6C—Y'0C* Olrj�l k—r�7UVz--j City Water J Well J Septic System J Sewer J Ins: HO S rt. Area Basement Garage Approved by Date Use Group Construction Type Revised 1108 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required distances from all other zones and is located=whicisng anditsuse is allowed. Signedl I hereby apply for a Certificate of Occupancy for the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS INSPECTION FIELD SHEET 04/07/22 • Printed by Middleton, Morgan 14 58 55 INSPECTION: 73413 FINAL PERMIT: STATUS: APPLICATION: 201500003 LOC: 12 GARDENIA LANE SOUTH WINDSOR PROPERTY ID: 34700012 OWNER: IGHANI FARIDEH CONTRACTOR: REQUEST BY: PROJ DESC: TO RE-ROOF 20 SQUARES WITH AN ARCHITECTURAL SHINGLE. WORK ORDER: INSPECTOR: ROSE RESULT: PASS REQUESTED: PRIORITY: SCHEDULED: COMPLETED: 04/16/15 UNPAID FEES 00 Date Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS: REROOF APPLICATION FOR HVAC PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR Pzptbirr# A BUILDING DEPARTMENT J 1540 SULLIVAN AVENUE 644-2511 ext. 230 Idg.Perini Date B ' ing Inspector Application must be printed or typed FEE SCHEDULE / Location of Job: $041,000=$15.00 r 2CZAM I& Over$1,000= Street No. Street Lot No. $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT �"� �'"u' CC, Ewe-, APPLICANT ADDRESS ka 6ox UL3 So. CT, APPLICANT'S PHONE# OWNER L t r 7 R OWNER�ADDRE`SSt „� OWNER PHONE F ESTIMATED COST$ O � (� IS THIS A CONTRACT COST? _i/Yes No � PEE ENCLOSED$ fl Z TYPE OF JOB: ESQR.COS New Installation 1 l Alteration/Addition/Repair � C� �� b Revised 03/05/10 APPLICATION FOR HVAC PERNHT(Continued from'ievem side) TYPE VSYSTEM: TYPE OF UII.DING: HEATINGRESIDENTIAL ❑ A/C ❑ COMMERCIAL ❑ VENTR ATION ❑ INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LBUT LBS. HIGH PRESSURE LDET 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) °F(HEAT LOSS SHEET MUST ACCOMPANYAPPLICATION) DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.) 4ei «f F GROSS HEATING CAPACITYONPUT-BTUH)- NET RATING(OUTPUT-BTUH) TYPE OF FUEL ❑ OIL-GPM 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(B i'UH) VENTILATION DESCRIBE ALL-AIR HANDLING EQUIPMENT(INCLUDING KITCHEN FNHAUST 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. CONTRACTORS LICENSE NO. V&k TYPE`, STATE SIGNATURE OF APPLICANT /11 . DATE O