HomeMy WebLinkAbout12 LAKEWOOD (MALLARD PL) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
Applica ' e TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
PROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date dmg n ecto �-^
Application must be printed or typed
FEE SCHEDULE Location of Job:
i -a /14 1�1-t js eO
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE# lfK-U �j/�/��—�/7.7 7
SOW (� 3�4 OWNER III El ��✓J�' ( .� OS51�1
OWNER ADDRESS '�� t Q D ���
OWNER PHONE
C ESTIMATED COST$
low IS THIS A CONTRACT COST? _Yes _No
Lam : ICJ FEE ENCLOSED$ lS c
1� TYPE OF JOB:
dSOR-Co New Installation
_Alteration/Addition/Repair
Revised 4/01H2002
1
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
�WEATING ❑RESIDENTIAL
❑A/C ❑COMMERCIAL
❑VENTILATION ❑ INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
M'fiYDRONIC ❑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)
D SCREBE ALL HEATING EQU ENT(INCLUDING MAKE&MODEL NO.)_
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH) _
TYPE OiFAS-�INPUT
OIL TANK LOCATION :❑INSIDE❑OUTSIDE CAPACITY
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)
DESCRH;E 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.
3r3 -� T/ s'-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT ` w`rx ��_ DATE Z-/7-dS
tIWN Sf4<
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O-P s,o� ?j&U&1at
ti � 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074
AREA CODE 860 / 644-2511
SORT
FIELD CORRECTION NOTICE
Permit Number Address of Property Date
During this inspection the following items were noted:
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