HomeMy WebLinkAbout12 SHADBUSH WAY APPLICATION FOR HVAC PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT
APP B 1540 SULLIVAN AVENUE ® C �
ri
Bldg.Permit#
. 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
$0-$1,000=$15.00 / �U��v��d Z,17 .
Over$1,000= Street No. Street Lot No.
$15.00 per$1,000 �YIr. / ^O . � �_1�'(J�P /
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C$
APPLICANT ADDRESS
APPLICANT'S PHONE#
OWNER /N , 4nr1a
OWN SF
� q( OWNER ADDRESS
� OWNER PHONE
ESTIMATED COST$ `�S I .5 D, nU
IS THIS A CONTRACT COST? Yes No
AV FEE ENCLOSED$ C� —
` TYPE OF JOB: aJ I yS I U
�SO R COS New Installation
Alteration/Addition/Repair
�IS000L�,
Revised 03/05/10
APPLICATION FOR HVAC PERMIT(Continued from ieverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
jo HEATING 9 RESIDENTIAL
❑ 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(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT-BTUH) T RATING(OUTPUT-BTUH) Z,
TYPE OF FUEL
O 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(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.
03
CONTRACTORS LICENSE NO. TYPE J STATE
SIGNATURE OF APPLICANT ten, DATE //
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