HomeMy WebLinkAbout0102803 HOSHKOSH
ON THE WATER
.lob Address 908 MERRITTAVE
Contractor
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
GRANT SCHULTZ HEATING & COOLING
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner DUSTY P/AMY L GROSS
Category 501 - Residential-Air Conditioning
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved ~ Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
102803
07/14/2003
Other J
Vent J
Use/Nature DUPLEX/Install new A/C in the lower level. *EIV form from Homeowner.
of Work
Fees: Valuation
Issued By:
$1,260.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$24.50
Date 07/14/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1411 S MAIN ST Oshkosh WI 54902 - 6519 Telephone Number
(920) 216-1616
~u~ 11 03 Ol:lOp Grant $ohultz HtC & R~C (920)237-4959 p.2
City o£ Oshkosh
Division of Inspection Services
P.O, Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
O/'t-IKO/H
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,.
Oshkosh WI 54903-1128. Commencing work without permit(s) will result/n fees being doubled or $100.00 plus the
normal permit fee, which ever is greater. ~,~
If YOU area conOtrgactor partici~atin~ in tJ~Perrr~t f2 Acc~o~nt System and have adequate funds, check t~er~.
if you w~m t~i.t p,'ocesscrI tn,'O,~h vo,r ~e¢o~,t [~q ;
,ZZ
. ,
JOB ADDR~ ~ ~ (err,
CHECK ~ ALL APPLICABLE
U~e'CATEGORY
~ingle Family ~Dup,ex F1Multi-Family
F1Rental ElCommercial Fllndustrial
FUEL CIGas [3Electric F1Solid SYSTEM ElNew FIReplace
EIOil ElSolar FIOther
TYPE
~Forced Air E]Radiant ElSteam E]A/C F1Vent F1Elech-ic F1Hot Water DSuppl. E1Con. Burner
IS CHIMNEY BEING LINED VINo [DYes - LINER SIZE & MANUFACTURER
Note: All chimuey$ shall be sized per the BTU's being vente&
CHIMNEY TYPE F'lChimney A F1Chimney B ElDirem Vent F1Other
I~EAT LOSS UIAs Approved FIExisting UINot Applicable
BTU RATE V1A~ Per Plan FIVariable VI0ther Value
DESCRIPTION OF ALL WORK BEING DONE A/-~t4.~ .~f/(~-- (~6'~/4~
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR /~/-~ OR ~ Electric Installation Verification form atlach~l(lfReplacemem)
£lectl~cal inslnllation of new/replacement equipment shall be done by licensed con tractors,
(we)
Electric Installation Verification
the homeowner(s) of
(print homeo .wrier(s) name)
(address where work is to be performed)
accept the responsibili~ for performing the electxical work as stated below for the property listed
above.
The nature of the work consists of: (Cheek one or Desen'be the Nature of Work)
Reconneetion or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconneetion or new circuit for replacement Electric Water Heater or power vented
water heater.
Reeonneetion of the Service Enhance Cable, Meter Box, alterations to receptaq!es
and lighting fixtures due to siding / soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reeonneefion or new circuit for the replacement of other permanently wired
appliances / :fixtures.
New circuit for the addition of A/C to an individual dwelling unit, including
required service electrical outlets. Note: Homeowners can only do their own
electric on a single family owner occupied home. Work on a condominivan,
duplex, rental, or multi-use building would require a licensed master
electrician.
Other
The value of this work is $.
I hereby verify this work wilt be performed by me and further verify the reeonneetion /
installation will be done in compliauce with manufacturer and Electric code requirements.
S) Signature