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DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
A7APPROVED71
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building In
Application must be printed or typed
Location of Job:
FEE SCHEDULE j [Tennant
Q /L � e /($0-$1,000="3 m o. Street Lot No.
IC Ayer$1,000st3-96'per$1,000
or any fraction thereof Designation Apt.No.
Z°) APPLICANT A14-6c-" I O, ( C d
APPLICANT ADDRESS
6 < , 0667
O7
APPLICANT PHONE#
Z -
SOW N 8Fq OWNER /7 a l f
O R AD RESS Z y
M E" OWNER PHONE G 6 -KY
C c GG] 3 ESTIMATED COST$ /d 0`
.� IS THIS A CONTRACT
//COSP O Yes &No
�G FEE ENCLOSED$ y
SOR co
TYPE OF JOB:
P-14ew Installation
0 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF BUILDING:
,O-REATING @LRESIDENT'IAL
❑A/C ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑ HYDRONIC Q-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)
��JJ DESCRIBE ALL HE/A G�EQUIPMENT(INCLUDING MAKE&MODEL NO.)
/ 7"77
GROSS HEATING CAPACITY(INPUT—BTUH)i'i 9, NET RATING(OUTPUT—BTUH)
TYPE OF FUEL , 6 r
U'OIL--GPM I I5 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 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 c_ r �
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.
303 �Y2 r � 7-
CONTRACTORS LICENSE NO. TYPE If SATE
SIGNATURE OF APPLICANT DATE
5/21/2021
A0 sf,
c
Town of South Windsor Building Department
OR
Tank Installation or Removal Permit : TANK-21-6
APPLICANT
NAME: Wayne Chalmers
EMAIL ADDRESS: wchalmers.highlander@gmail.com
ADDRESS: 249 Lawrence rd 249 Lawrence rd
South Windsor, CT 06074
LOCATION
ADDRESS: 249 LAWRENCE RD
South Windsor CT 6074
OWNER: CHALMERS WAYNE S
249 LAWRENCE ROAD
SOUTH WINDSOR CT 6074
DESCRIPTION OF WORK:
removal of 25 gallon tank
April 11, 2021
BUILDING OFFICIAL DATE SIGNED
-ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT-
PERMIT ONLY VALID IF SIGNED BY BUILDING OFFICIAL-
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