HomeMy WebLinkAbout145 PINE TREE LN DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
AppIicati PERMIT#by: TOWN OF SOUTH WINDSOR �
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date i ing lnspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT /111L C Y✓1
APPLICANT ADDRESS -.2 1- z2tw C vQ
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APPLICANT PHONE# cj
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< OWNER ADDRESS en r
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+ OWNER PHONE
C ESTIMATED COST$
.� IS THIS A CONTRACT COST? _Yes _No
FEE ENCLOSED$ 9-
O�� TYPE OF JOB:
OR C " New Installation 1
Alteration/Addition/Repair
Revised 4/01//2002 /3
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF OILDING:
❑jiEATING G'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 °F 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) 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 �.2 COOLING CAPACITY(BTUH)-1
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.
9 3 0( J C .
CONTRACTORS LICENSE NO. TYPE STATE
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SIGNATURE OF APPLICANT v DATE/,
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