HomeMy WebLinkAbout263 LONG HILL RD DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT —
APPR vE 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
Sc�
APPLICANT PHONE#SOW N SFq OWNER 7 X 0 UX
OWNER ADDRESS
-Sze tt 7�1t ell��ie/�-r a r(./ C'�?
o F OWNER PHONE ! 0
C D ESTIMATED COST$ d 75 ,
IS THIS A CONTRACT COST? Yes _No
FEE ENCLOSED$
r�OsO' O�� TYPE OF JOB: IL
R C New Installation
'v Alteration/Addition/Repair
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF ILDING:
HEATING WRESIDENTIAL
❑A/C ❑COMMERCIAL
U VENTILATION Cl INDUSTRIAL
HEATING
❑ STEAM LOW PR��ES�� LIMIT LBS. HIGH PRESSURE LIT LBS.
0 HYDRONIC �'V��AAR LIMIT
RM AIR O 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 HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
11?45 L �73 a tc 4at d
GROSS HEATING CAPACITY(INPUT—BTUH)� NET RATING(OUTPUT—BTUII). Dap
TYPE OFfiUEL
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) I
FURTHER DESCRIPTION OF WORK lZ
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- ( CT,
CONTRACTORS LICENSE N TYPE STATE
SIGNATURE OF APPLICANT DATE ! �!S