HomeMy WebLinkAbout25 IMPERIAL DR DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Applicati . ereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
PRO 1540 SULLIVAN AVENUE
L� 644-2511 ext. 230 Bldg.Permit#
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Date Buil Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
25= t \ Ibc
$0-$1,000=$15.00 FTenant
Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof gnation Apt.No.
APPLICANT r'i (-O
APPLICANT ADDRESS
S t 1y
APPLICANT PHONE#
SOW N SF,q OWNERv.Q.,s
OWNER ADDRESS
OWNER PHONE Ll��l'OL}Sy
C ESTIMATED COST$
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IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$_ Epp pG�
SO O TYPE OF JOB:
R C _New Installation
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✓Alteration/Addition/Repair
Revised 4/ 1/2 002w`
1�1 1
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF YYTEM: TYPE OF UILDING:
HEATING RESIDENTIAL
El`A/C ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ TEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
ro HYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER
tKISTING 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 HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH)
TYPE OF FUEL
a6lL-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 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 C1 R \ J
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.
y�2--1 �T S - � C`V
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT �� r� nn-P� DATE Z 2 ',/ ()
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