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CITYOFBRIDGEPORT,BUILDINGDEPARMENT APPLICATIONFORAWETHEATPERMIT IHEREBYMAKEAPPLICATIONFORAPERMITFORMECHA NICALWORK HOLDHARMLESS/RELEASE APPLICATIONFORMECHANICALWORKPERMIT PermitNo. Date (City of Bridgeport)

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The CITYOFBRIDGEPORT,BUILDINGDEPARMENT APPLICATIONFORAWETHEATPERMIT IHEREBYMAKEAPPLICATIONFORAPERMITFORMECHA NICALWORK HOLDHARMLESS/RELEASE APPLICATIONFORMECHANICALWORKPERMIT PermitNo. Date (City of Bridg form is 1 page long and contains:

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Form1230(4.6.20)

CITYOFBRIDGEPORT,BUILDINGDEPARMENT

APPLICATIONFORMECHANICALWORKPERMIT

Building

Permit#_________

HOLDHARMLESS/RELEASE

CityofBridgeportandBridgeportBuildingDepartmentrequiresthatpermitteeshallindemnifyandhold‐harmless"City/Department",

it's employeesandagentsand release both from anyandallclaimsonactionsbroughtby third parties for injuries or damagesof

property in connection with granting of this permit and work to be performed there under. Permittee may be required to insure

againstsuchclaimsinamountsappropriatetomeetsuchobligation.City/Departmentshallhavetherighttoreviewandspecify

suchamountandscopeOfcoverageasitmaydeemappropriateforactivitiesconductedunderthispermit.

IHEREBYMAKEAPPLICATIONFORAPERMITFORMECHA NICALWORK

INABUILDINGASHEREINAFTERDESCRIBED:

AddressofWork NearestCrossSt

Owner

Owner’sPhone

OwnerAddress City/Town State:

Zip:

APPLICATIONFORAWETHEATPERMIT

PermitNo. Date

 HOTWATERorSTEAM

degreesFinsidewhen degreesFoutside degreesFboilerwater psi

Unit:Make Model FuelUsed

GrossOutput B.T.U./hr. Mfgrs.ChimneySpecs x Height

TotalHeatLossofBuilding B.T.U. No.OfZones

DescriptionofHeatingunits(Radiation)

Type Make Model

TotalQuantityInstalled TotalOutput BTU

TypeofSystem

EstimateofValue$ Contractor:

ReceiptNo. Signature

Fee BusinessAddress

Inspector Date Conn.StateLicenseNo. Phone

APPLICATIONFORWARMAIRHEATPERMITORVENTILATIONSYSTEM

PermitNo. Date

WARMAIRSYSTEMor SPACEHEATER HEATPUMPS

degreesFinside whendegreesFoutside

Make Model FuelUsed

NetLoadRatingofFurnace B.T.U./hr. Mfgrs.ChimneySpecs x Height

TotalHeatLossofBuilding B.T.U. No.OfZones

FanRating C.F.M.at100degreesFRise

MakeandModelofMech.DraftEquip.(ifused) TotalHeatLossofBuilding BTU

EstimateofValue$ Contractor:

ReceiptNo. Signature

Fee BusinessAddress

Inspector Date Conn.StateLicenseNo. Phone

APPLICATIONFORAIR‐CONDITIONINGORREFRIGERATIONPERMIT

PermitNo. Date

DesignConditions:Inside DegreesF. Outside degreesF.D.B. OutsidedegreesF.W.B.

AreatobeConditioned(sq.ft.) TotalRefrigerationRequired(BTU/hr) Refrigerant

Make Model

No.CoolingMachines Type TotalCapacity

TypeofCondensingEvap.AirCityWaterCoolingTowerOther(Describe)

TotalFanCapacityofAllSystems(CFM) FreshAir(CFM) HeatPumpYesNo

DescriptionofHeatingunits(Radiation)

Type Make Model

EstimateofValue$ Contractor:

ReceiptNo. Signature

Fee BusinessAddress

Inspector Date Conn.StateLicenseNo. Phone

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CITYOFBRIDGEPORT,BUILDINGDEPARMENT APPLICATIONFORAWETHEATPERMIT IHEREBYMAKEAPPLICATIONFORAPERMITFORMECHA NICALWORK HOLDHARMLESSRELEASE APPLICATIONFORMECHANICALWORKPERMIT PermitNo. Date (City of Bridgeport)

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Completed 22 January 2021

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