HomeMy WebLinkAbout120 HILLSIDE DR DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT RMrr#
Ap n TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
Al PRO 1540 SULLIVAN AVENUE
644-2511 ext. 230
L2 6--M -,—
Date B ding Inspector Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE _
$0 - $1,000 - $12.00 Floor Apt. No.
Over $1,000
$12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS 01 d �c�-S, ,e
OWNERS PHONE#
APPLICANT �p L
'to*
oW N $F,q ADDRESS (AQ�--O Qa N1 \
$ _57
ESTIMATED COST
IS THIS A CONTRACT COST?
YES NO
. . �� FEE ENCLOSED $ �U•
TYPE OF JOB: I (O I
Original Installation
Alteration/Addition
Revised 11/95
lq�i
A
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM /TYPE OF BUILDING
HEATING �/ RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONICZ WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
TOTAL HEAT LOSS(BTUH)
(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT (INCLUDING MAKE dt MOD L NO.)
f �: �'
GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING (OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM GAS-INPUT ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
AIR CONDITIONING
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
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 CONN. BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
o���
STATE LICENSE-NO.NA +C-ME&TYPE SIGN OF OF PLICANT
PHONE NO.lD I DATE IG`
1 `
• I "
• \ t{
_3_'�1
'1 "t 11 �l S
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT 4
Application is hereb}-: TO\ N of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APP 1540 SULLIVAN AVENUE
644-2511 ext. 230
Date Building Ins for
Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER 1k, k-.rO ,r L
or any fraction thereof
ADDRESS
S N� k, � .c�� ` y�
OWNERS PHONE#
APPLICANT
OW 1 SF,q ADDRESS
OESTIMATED COST S m g) n
C = IS THIS A CONTRACT COST?
YE NO
FEE ENCLOSED $
OR*C 0 TYPE OF JOB: 1 S
Original Installation
_Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING � RESIDENTIAL 1/
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 F INSIDE F DIFFERENCE F
TOTAL HEAT LOSS(BTUH)
(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
`^n DESCRIBE ALL HEATING Eq UIPMENT(INCLUDING MAKE&MODEL NO.)
`� Y `
GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING (OUTPUT-BTUH)
70
TYPE OF FUEL
OIL-GPM GAS-INPUT �Q�� ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
AIR CONDITIONING
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
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 CONN.B ING CODES IN THE
PERFORMANCE OF SUCH WORK.
STATE LICENSE-NO. NAME&TYPE ! SIGNATURE OF APPLICANT
PHONE N0j""�2\-t 3 'P DATE tQ g
� o
.
76
t t,
:, 41
Dk
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Pr, ` 3 c a �L4 T (-Iz-1
• • � : WILL-JAM
� t'`� �':'= '- s r .� . ' 30�-r� ��: ••� � � � ��. c ors ->.•
i
ED
TO V* MINDING DEPT. TOWN OF SOUTH WMgSOJ
1Dla certified that this plan and speciflt,tlons gre true
eopies of the proposed building or Alterations $e b+
erected at
I Z o N,115 de Dr, streat
together with amendments stated in application and
1 filled with plan and i agree to comply with all zoning,
Lo Building and state taws and such orders al; shall b,
:sued by the Building Department during pendency
l /� of this application and final Mavam» of a bUydlfig
Lit permit.
signed
This plan is apprived subject to the corMlttae thgt
orders and ord,nancea regulating tluMdleg ehaM go
demplied with.
Osnditionally Approved These MIS No
By Wing Inspector �� Clerg
Dell ��� me. —Y.LU —
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