HomeMy WebLinkAbout0102657-HVAC (a/c)OSHKOSH
ON THE WATER
Job Address 523 GEHRES CT
Contractor
Fuel
System
ClTY OFOSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
HOLLAUS HEATING & NC SERVICE
] IGas I I IOil
[] New ...... ~
L~ Forced Air I L~ Radiant
[~' Electric ] I J Hot Water
Owner LORRAINE J SCHULTZ REV TRUST
Category 501 - Residential-Air Conditioning
L~J Electric
[] Replace
Steam
Suppl.
L,.J Solar
~ A/C
No '102657
Create Date 07/07/2003
Plan
Chimney Type K ~ Chimney A ~,~ Chimney B
Heat Loss ~.) As Approved {.,) Existing
BTU Rate K ~ As Per Plan ~.) Variable
I ~1- Solid -~
[] Other I
LJ vent
[] Con. Burner
Direct Vent O Not Applicable I
~ Not Applicable I Value
O Other I Value
Use/Nature ~FR/Replace AC of Work
Fees: Valuation
Issued By:
Plan Approval
$0.00 Permit Fee Paid
[] PermitVoided I
$27.50
Date 07/07/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Agent/Owner
Address 1535 W BENTAVE OSHKOSH WI 54901 -2730 Telephone Number
(920) 235-7397
City of 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 al%r bold categories must be provided.
Incomplete applications ',rill not be processed.
· 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 in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit tee ACcount System and have adequate funds, check here
if you want this processed through your account ['
CHECK [~ ALL APPLICABLE
USE CATEGORY
.l~Single Family F1Duplex F1MultirFamily
F1Rental F1Commercial EIIndustrial
FUEL ElGas [3Electric [3Solid SYSTEM F1New ~i~Replace
I-1Oil [3Solar [3Other
TYPE
l~Forced Air F1Radiant [3Steam ~]3JC EVent F1Electric UIHot Water [3Suppl.[3Con. Burner
IS CHIMNEY BEING LINED [3No r-lYes - LINER SIZE
Note: All chim-neys sb~l be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE r'lChimncy A [3Chinmey B [3Direct Vent [3Other
HEAT LOSS [3As Approved [3Existing [3Not Applicable
BTU RATE EIAs Per Plan [3Variable [3Other Value
DESCRIPTION OF ALL WORK BEING DONE ~/~P/~/~ e~ 't~/
VALUE (Including labor and all materials including light fixtures) $ /.' ~"d> O- 6~ ....
ELECTRICAL CONTRACTOR ~ ~ OR
- . - ,, ~ ~ Electric Installation Verification form attached(If R~placement)
Elect~cal installation of new/replacement equipment shall be done by licensed contractors.
O/HKO/H
City of Oshkosh
Division of Inspection Services
215 Chttrch Avenue
PO Box 1130
Oshkosh WI 54903-I I30
Office 920-236-5050
Fax 920-236-5084
Electric Installation Verification
I (We)
(Electrical Contractor Name)
(Address) (City)
(State) (Zip Code)
have been contracted to perform electric installation work for .J-~$
(Name of party contracted to)
at the following address: _ff".~..~
(Addzess. where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
_X ecormectlon or new clrcmt for replacement Heating Plant and/0~~'
ReconnectiOn or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reconnection or new cimuit for the replacement of other permanently wired
appliances / fixtures.
__ New circuit for the addition of A/C to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $ ,J~ tT~
I hereby verify this work will be performed by an employee of this company and further verify
the rec0nnection / installation will be done in compliance with manufacturer and Electric code
requirements.
'~e of ~"~m~-any Officer)
(Print Name of Officer)
(Date)
5/O2