Form1230(4.6.20)
CITYOFBRIDGEPORT,BUILDINGDEPARMENT
APPLICATIONFORMECHANICALWORKPERMIT
Building
Permit#_________
HOLDHARMLESS/RELEASE
CityofBridgeportandBridgeportBuildingDepartmentrequiresthatpermitteeshallindemnifyandholdharmless"City/Department",
it's employeesandagentsand release both from anyandallclaimsonactionsbroughtby third parties for injuries or damagesof
property in connection with granting of this permit and work to be performed there under. Permittee may be required to insure
againstsuchclaimsinamountsappropriatetomeetsuchobligation.City/Departmentshallhavetherighttoreviewandspecify
suchamountandscopeOfcoverageasitmaydeemappropriateforactivitiesconductedunderthispermit.
IHEREBYMAKEAPPLICATIONFORAPERMITFORMECHA NICALWORK
INABUILDINGASHEREINAFTERDESCRIBED:
AddressofWork NearestCrossSt
Owner
Owner’sPhone
OwnerAddress City/Town State:
Zip:
APPLICATIONFORAWETHEATPERMIT
PermitNo. Date
HOTWATERorSTEAM
degreesFinsidewhen degreesFoutside degreesFboilerwater psi
Unit:Make Model FuelUsed
GrossOutput B.T.U./hr. Mfgrs.ChimneySpecs x Height
TotalHeatLossofBuilding B.T.U. No.OfZones
DescriptionofHeatingunits(Radiation)
Type Make Model
TotalQuantityInstalled TotalOutput BTU
TypeofSystem
EstimateofValue$ Contractor:
ReceiptNo. Signature
Fee BusinessAddress
Inspector Date Conn.StateLicenseNo. Phone
APPLICATIONFORWARMAIRHEATPERMITORVENTILATIONSYSTEM
PermitNo. Date
WARMAIRSYSTEMor SPACEHEATER HEATPUMPS
degreesFinside whendegreesFoutside
Make Model FuelUsed
NetLoadRatingofFurnace B.T.U./hr. Mfgrs.ChimneySpecs x Height
TotalHeatLossofBuilding B.T.U. No.OfZones
FanRating C.F.M.at100degreesFRise
MakeandModelofMech.DraftEquip.(ifused) TotalHeatLossofBuilding BTU
EstimateofValue$ Contractor:
ReceiptNo. Signature
Fee BusinessAddress
Inspector Date Conn.StateLicenseNo. Phone
APPLICATIONFORAIRCONDITIONINGORREFRIGERATIONPERMIT
PermitNo. Date
DesignConditions:Inside DegreesF. Outside degreesF.D.B. OutsidedegreesF.W.B.
AreatobeConditioned(sq.ft.) TotalRefrigerationRequired(BTU/hr) Refrigerant
Make Model
No.CoolingMachines Type TotalCapacity
TypeofCondensingEvap.AirCityWaterCoolingTowerOther(Describe)
TotalFanCapacityofAllSystems(CFM) FreshAir(CFM) HeatPumpYesNo
DescriptionofHeatingunits(Radiation)
Type Make Model
EstimateofValue$ Contractor:
ReceiptNo. Signature
Fee BusinessAddress
Inspector Date Conn.StateLicenseNo. Phone