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HomeMy WebLinkAbout23 LAKEWOOD APPLICATION FOR HVAC PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT �rjU O b 3 AP OV 1540 SULLIVAN AVENUE 1y4 n 644-2511 ext. 230 Bldg.Permit# Date Building Inspee9r, Application must be printed or typed FEE SCHEDULE t Location of Job: $041,000=$15.00 Over$1,000= Street No. Street Lot No. $15.00 per$1,000 LA& WU or any fraction thereof Tenant Designation Apt.No. APPLICANT---,I k& APPLICANT ADDRESS J ✓e APPLICANT' P ONE# OWNER O �1C�J4 0*0W N sFq� OWNER ADDRESS OWNER PHONE 8 -7 7 ESTIMATED COST$ Lq C � ,.� U IS THIS A CONTRACT COST? es No FEE ENCLOSED$ i TYPE OF JOB: cZ2 3 dsOR•CoN New Installation (/Alteration/Addition/Repair Revised 03/05/10 J APPLICATION FOR HVAC PERMIT(Continued from reverse side) TYPE OF STEM: TYPE OF BUILDING: HEATING ❑ RESIDENTIAL ❑ A/C ❑ COMMERCIAL ❑ VENTILATION ❑ INDUSTRIAL HEATING O ,vTEAM LOW PRESSURE LMffT LBS. HIGH PRESSURE LIMIT LBS. l'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) DESCRIBE ALL HEA G QUIPMENT(IN UD MOD Nay ,N �l C �� � a �� i w � `_A \� L L.�/` GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH) TYPE OF FUEL ❑ OIL-GPM OIL TANK LOCATION: ❑ INSIDE ❑ OUTSIDE CAPACITY ❑ GAS-INPUT L,-- 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(- 3w8D6 s - l � � CONTRACTORS LICENSE NO. TYPE STATE r/ SIGNATURE OF APPLICANTI`_/`,/� `zl� DATE /j J TWO! M:e.chani'c_at LLC.� t41115;� Ti l,'Nicholas De I'Aera authorize (agent) d to sign the bu Iding permit application as my agent to perform work at: Address: ;7X) j; I k .i � r _ i ascription: E0 b'�ame or 4 1 V -7?K7 6�o arting Date: 1--13 -K License Type and Number: jD Agent Signature: Lic'enseContr ctorSignature: I. 'j M'! 140 N�w Britain Ave Plainville CT 06062 Phone 860 314.1518 Fax 860.314.1613 License # P1278957 SM12534 S1394806 Electric# APPLICATION FOR BUILDING PERMIT Plumbing# 23 l akewood Date: Y HVAC # Sprinkler# _3 Q 9 7.4 Estimated Cost ; 0 FINAL RO _ BuildinV,; tt aL COMPLETE RED BOXED AREAS Permit Fee ; En nee n Occupancy Fee ; Affidavit TYPE OR PRINT ONLY Eng. Insp. Fee ; Appr. for CO. SIGN ON REVERSE SIDE Total Fee ; TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) ; The undersigned hereby applies to do work according to the following: ` Applicant /.I ^5 Location of Work 3 LQ key a i Lot No. Applicant's Address ry.-C 74 G.,4cy 5r. Tel.# S L8-W40 Town E cr Zip o6tV5 Lic.# Owner Architect Owner's Address 23 Architect's Address Zip Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd A. Total New Area Purpose of this prmit TCe./" J9 Itiya,-r 6f �3 S�►� les- T,,,s t�(! << r w�{�r- f—r City Watero Well❑ Septic System❑ Sewero Ins: HO Area Basement Garage Approved by Date _ Use Grou onstrucrion Type�—�� RwlsNl 6102 I hereby agree to conform to all the requirements of the Lays of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required distances from all other zones and is located in which this building and its use is allowed. Signed �-'a I hereby apply for a Certificate of Occupancy for the work described in this application for the permit. 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I of I 203 644.46911 f Sow wl��' }1 act 101 �Sy �NA', j r ' I,n and sAecra tie rat�^� "d tt.ts P utiding ttti tn3t b er Tpis eer the Prvn,aed §EFe�I of coPtes1oA a�f elect _ i;� 76o1A • t ,.d wit ,.n1y ytt+ it.halt ge t ra:'rs a$>�deneY o c toge}het '"'t•' � duilnB uHdtil� n ,T w�1n`, Hie$ 1 R' ',., tsen.:axe of ' ,nA ttn� _ I�44tSVE� `' t1 , s"tf this .i'! ti0 i31'ahea y_s y ,,... e ka8 wt ta n ( It3 p nd ..�a• e� Fs a _ laoMptied Wljyy PPPlO�a4 �0ttto^° rye }„` '"�` � .r•'^'_ e 1500031 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER HVAC PERMIT DATE: 01/29/2015 GIS ID: 51900023 FEE: 135.00 MUNIS APPLICATION# 201500068 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: TOTAL MECHANICAL SYSTEMS ADDRESS: 23 LAKEWOOD ADDRESS: 140 NEW BRITAIN AVENUE OWNER: FORNWALD ROBERT C PLAINVILLE,CT 06062 23 LAKEWOOD SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: EMERGENCY REPLACEMENT OF BOILER WITH A COMBINATION GAS BOILER. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 1/29/2015 12:55 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE