HomeMy WebLinkAbout255 SULLIVAN AVE DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Apph hereby: TOWN OF SOUTH WINDSOR -' -
BUILDING DEPARTMENT
APPR 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
Date Bftng Inspector t02'�
Application must be printed or typed
FEE SCHEDULE ,
Location of Job:
FTenant
su11^Van k
$0-$1,000=$15.00 Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof gnation Apt.No.
APPLICANT M �--MQR6 SM-eC h OJ-)i CO—(
APPLICANT ADDRESS 1-7� )LI1 1,� PQ l LjY1P
(Z,)a S I Dy) ht 1 -1 �0 4- (*)L0C6 3
APPLICANT PHONE#
Ow N SC OWNER Pad I.
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OWNER ADDRESS _c5w l l yan {91 J. au
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O OWNER PHONE
ESTIMATED COST$ !Zo 00
IS THIS A CONTRACT COST? _Yes _No
�L
�G FEE ENCLOSED$
SOR CO�� TYPE OF JOB:
_New Installation
X Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
❑HEATING `RESIDENTIAL
❑A/C ❑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) T(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL
ICI # XL !a S-3 �Yrn j ess ,cre (P
Curl S -0tor e) i 10 4� owe'-sire )"yy
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH)
TYPE OF FUEL
❑ OIL--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
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.
-I 39 J T
CONTRACTORS LICENSE N (t� TYP STATE
SIGNATURE OF APPLICANT DATE (� iy