HomeMy WebLinkAbout201 WYNDEMERE CT BLDG 2 DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PEWIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT �& �
APPROVED 1540 SULLIVAN AVENUE
Bldg. Permit#
644-2511 ext. 230
L •S• o�
Date Building Inspector
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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT .Gd U L roll,
APPLICANT ADDRESS 136 ?Cyr. S�L,
APPLICANT PHO`N/E'/# �9G O/ �L�— C12
OWN Se OWNER G C. 4 X P/e--r
O 4 / (, -r-. �D
Q O /OWNER PHONE 6 S��
[►
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes 440
FEE ENCLOSED$ 7 C U
��� TYPE OFF JOB: ���
�R C �1Vew Installation �? j LP
—Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF.,, SYSTEM: TYPE OF BUILDING:
0-HEATING ❑RESIDENTIAL
D A/C D 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)
GG �CRIBE ALL HEAT14p EQUIPMENT CLUD! I G MAKE NO.)
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH)
TYPE OF FUEL
5'0IL-GPM��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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT .� DATE
r
S �
APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT
1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 (PHONE) 860-644-2511 EXT. 230
DEPARTMENT DECISION PERMIT NUMBER:
APPLICATION IS HEREBY: I
APPROVED: BLDG.PERMIT NUMBER:
4ATE
Q4 INSPECTOR
LOCATION OF WORK: ��I V ����/r��� GO G✓
APPLICANT: OWNER: TYPE OF STRUCTURE:
" �" //-- O NEW BUILDING
NAME: ,,//
�/ ~-r NAME: iI?[/� I/o�J
O ADDITION
PHONE NUMBER: PHONE NUMBER �l�/` 7 1 p4-ItSTING BUILDING
ADDRESSES:I36 �KL/ c ADDRESS:,2o 4,)/ je/-w o;K a C;- _ TYPE OF USE:
SIDENTIAL ❑COMMERCIAL
HVAC INFORMATION: FURTHER DESCRI/PTION F WORKr
TYPE OF SYSTEM: ❑HEATING o A/C /G' I `/' ` a
HEATING:
TOTAL HEAT LOSS(BTUH) °F (HEAT LOSS SHEET REQUIRED)
DESCRIBE ALL HEATING EQUIPMEN15INCLUDE MAKE AND MODEL NO*
3, s0-c,k 5-1 e 11,E w / ,
ESTIMATED COST:S
AIR CONDITIONING: 60
DESIGN TEMP:OUTSIDE °F INSH)E °F DIFFERENCE P FEE ENCLOSED:S
TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET REQUIRED)
DESCRIBE ALL COOLING EQUPMENI(INCLUDE MAKE AND MODEL NO.):
FEE SCHEDULE:S18 PER$1,000 OF THE ESTIMATED COST.
ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS
SLOO 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 IIN2THE PPERFOMANCE OF SUCH WORK. `y--
CONTRACTORS LICENSE NO.: �7(JJ�O L TYPE: �I STATE: �(
SIGNATURE OF APPLICANT- DATE: 7