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HomeMy WebLinkAbout1475 MAIN ST DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT# TOWN OF SOUTH WINDSOR ��(,� Application is hereby: BUILDING DEPARTMENT -oo o� ` APPR vE 1540 SULLIVAN AVENUE Bldg. Permit# 644-2511 ext. 230 Date Build'ing Inspect Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 FTenant Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT APPLICANT ADDRESS APPLICANT PHONE# Is O)N N S,1 q OWNER OWNER ADDRESS j\�4 S k3 V yo_n (Z— OWNER PHONE \- C ESTIMATED COST$ +r IS THIS A CONTRACT COST. �es _No FEE ENCLOSED$ \ 0 u TYPE OF JOB: j l;o l SCR•C� New Installation visl _.L,4teration/Addition/Repair Revised 4/01//2002 APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM: TYPE OF UILDING: ❑HEATING RESIDENTIAL ❑A/C I COMMERCIAL ❑VENTILATION ❑INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LDMT 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) °F(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 NGOIL—GPM OIL TANK LOCATION INSIDE❑OUTSIDE CAPACITY�O AS—INPUT LPG TANK CAPA TY ELECTRIC—KW 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 �T � �` n\� n r V C.Ie yNY Q 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. ?) U -1-, � --� � S- C ,\ CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT �� (� �, , �� DATE 2/CZ\A /U �S A 27 i Z" W \ .1 S D 41 n NA Z C v. 4 2,4`t , 6 T ia�LW- �.► G O nt A u 'S 0 --► �1, ` 0 v A� t o o Zo0 . 4 4' toes ,moo' �) ..n©..,. Ej o'er '- Z7 '- 3Z" �- n•�on,_ O 6 i N 1'I � I \N :..G+i 0 7 7 q' f��'��.• ��A1.1 S-'R�.%'AR cc C:-, 3`Y' ST-A Al L `C W S ZCi STd W 1 G.vC l T2. t� 117 7c- f• C k Y7lp �� J 2 L L L � S' r ',� ►-���t M 4-1.5- �.5"Z S M �.�-� ti'a--;'S- �� �'�.��ib�_� O d►� . 3d�•. 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P'nti R'1°'ter_.aOF CON `S"� AI l,i� 0 PA 77 C�ARj..!�G F�AoR E�� ..:�Z.b �'3 s° �aOl.1 r-!S W \ l-1��c ,_� >ti t_-' G c.�. � c-- •��+FRfO LAn'D g)�E. ^nm � r O G-'t'o� Z.S 't �/B.TL►-1 ON.�P GO N 1.►>=CST G v"T xc 17 7c, A OF r;,+JTH WIN .:,�GINEERL' D_PARTP.' t E: /p- T99-79 SIG.: /T 19 21AYZ� - APPLICATION FOR HVAC PERMIT TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 (PHONE)860-644-2511 EXT.230 PERMIT NUMBER: DEPARTMENT DECISION APPLICATION IS HEREBY: APPROVED: BLDG.PERMIT NUMBER DATE INSPECTOR ' LOCATION OF WORK: � / /✓_ APPLICANT: OWNER: TYPE OF STRUCTURE: ❑NEW BUILDING NAME: �lil✓S O-� GsrsG-K NAME:Ti'Cy�✓l�/U /�iG "` - o ADDITION PHONE NUMBER. YO- ��8 O G 6 PHONE NUMBER_ I / Y3�1- //127 y g6ISTING BUILDING ADDRESS:/,?b/ X y C 'I/ ADDRESS; i/! S d' TYPE OF USE: 1Dr/ft�t Wo/I��G'^� Gr• Q(;07Y � �n � �/�`, ��(i7(/ o46SIDENTIAL o COMMERCIAL HVAC INFORMATION: Q�FURTHER DESCRIPTION OF WORK: TYPE OF SYSTEM: .419ATING ❑A/C �N S!R(/�*7 �f yv�C 4 e. e2&01 HEATING: TOTAL HEAT LOSS(BTUH) °F (HEAT LOSS SHEET REQUIRED) DESCRIBE ALL HEATING EQUIPMENT(INCLUDE MAKE AND MODEL NO. ESTIMATED COST:S Co AIR CONDITIONING: Q DESIGN TEMP:OUTSIDE 'F INSIDE 'F DIFFERENCE F° FEE ENCLOSED:S /v TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET REQUIRED) DESCRIBE ALL COOLING EQUPMENT(INCLUDE MAKE AND MODEL NO.): FEE SCHEDULE:SIS PER S1,000 OF THE ESTIMATED COST. ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS $1.00 OVER (.26 CENT EDUCATIONAL FEE INCLUDED AS PART OF THE PERMIT FEE) THE UNDERSIGNED HEARBY 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 PERFOMANCE OF SUCH WORK. CONTRACTORS LICENSE NO.: TYPE. ( STATE: 0 SIGNATURE OF APPLICANT: DATE: �IZ12-Q o�pdo 6�Co 39