HomeMy WebLinkAbout122 BEELZEBUB RD DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR 3��
BUILDING DEPARTMENT
APPROVEA 1540 SULLIVAN AVENUE Bldg.Permit#
0
644-2511 ext. 230
ate uilding Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
/-2.a2 e 2 G as
$0-$1,000=$15.00 Street t No. Street Lot No.
Over$1,000=
$15.00 per$1,000
7
or any fraction thereof Tenant Designation Apt.No.
APPLICANT i'' f1 of c�G on+ ��/i G It C
APPLICANT D SS ra
n �'T
APPLICANT PHO # 96 O
�0W N SFq OWNER �
OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$'3 9'0 D. O O
IS THIS A CONTRACT COST? IXYes _No
FEE ENCLOSED$ (p0
TYPE OF JOB:
SOR.Cod New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF S EM: TYPE OF B LDING:
EATING ISIDENTIAL
❑A/C D COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
D^S AM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
I'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 ACCOMPANY
APPLICATION)
,Q DESCRIBE A/ L HEATING EQUIPMENT
/(IN.jCJi UDING MAKE&MODEL N7.)
y
/Ct-»...,..c /��r,LT,:u �,.Ss,/C�7is�T'�!/ �d, .�J[c✓ %�'>/Fi-G
�u.-►�sa n Oi.�/ .� -1 Q O
GROSS HEATING CAPACITY(INPUT BTUH)% NET RATING(OUTPUT—BTUH) /7
TYPE OF�L
L°(OIIr-t PM/an OIL TANK LOCATION:0 INSIDED 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.
S '7 308 �5� 's
CONTRACTORS LICENSE NO. 01 E STATE
SIGNATURE OF APPLICANT DATE a -•Z 0- 0'G
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HFATING,PMNGkCOO�9'�CONTRACTOR
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i
i
Electric# BeelzebubAPPLICATION FOR BUILDING PERMIT
# 12 2 Road
Plumbing 800519 Date: l(D U
HVAC #
Sprinkler# _
Estimated Cost $
FINAL APPROVALS --- -- - __
Building COMPLETE RED BOXED AREAS OccupancPermit Fee $
Engineering TYPE OR PRINT ONLY Eng. Insp.yFee $
Affidavit
pr. for CO. ► SIGN ON REVERSE SIDE
PP -- -- — TotalFee-t+- $_ ._t�✓
TO THE BUILDING DEPARTMEN
T,TOWN OF SOUTH WINDSOR, CT (Additional o>!t
The undersigned hereby applies to do work according to the following:
Applicant ���'�' Location of Work Lot No.
Applicant's Addres P4)6.0)0 /3 i Tel.# �J&S1 013 7
Town or�TlaQig 'o�/3�y C'� Zip 0&073 Lic.# S&,14Jt
Owner_- Z>O-A) SA41/'h Architect
Owner's Address /ZZ B e e1 Z,e u/ Architect's Address
Zip Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit462ST7)Gv G `v "gnU Yto►' UL l���Ea A r �✓ut jr yd rt-
City Watery Well❑ Septic System❑ SewerOP,
Ins: HO SP Cert. Area Basement GS Garage
Approved by Date • Use Group Cons' on Type
Revised W02
IKi>
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 alteraLo in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located th p p stance from all street lines,side yard lines,and required
distances from all other zones and is located in vyhich this buil g nd i use is allowed.
Signed
P&e V 9-?rl(o Cu(
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