HomeMy WebLinkAbout0102674-HVAC (furnace & a/c)(~ CITY OF OSHKOSH No 102674
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1130 BUCHANAN AVE Owner RUSSELL G/SHARO HANDY JR
Contractor TENTH STREET STATION INC Category 502- Residential-Both
Fuel ~ Gas ~ ~ Oil L~ Electric ~ Solar I L~ Solid
System ~ New ~ ~ Replace ~ L~ Other
~ Forced Air I ~ Radiant L~ Steam ~ A/C 1
~ Electric I ~ Hot Water L~ suppl. L~ con. Burner 1
Chimney Type I~ Chimney A ~ Chimney B O Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value 0
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 75m heat & 24m cool
Create Date 07/07/2003
Plan
Vent J
Use/Nature SFR/Replace furnace and A/C. *ElY form from Drexler Electric.
of Work
Fees: Valuation $3,300.00 Plan Approval $0.00 Permit Fee Paid $54.50
Issued By: Date 07/07/2003
Permit Voided J
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 924 OHIO STREET OSHKOSH WI 54902 -0 Telephone Number 236-8770
~FRO~ ~TENTH STREET STATION) INC. FAX NO. :920-236-0150 Jul. 07 2~3 10:{~qM R3
Ci~ of Oshkosh
Division of
P.O. Box 1130
P~ne (~20) 236-5050
F~ (920) 23~50~
O/HKO./H
HVAC PERMIT APPLICATION
All mfOXlVat/on at'te~ bold catego~es m~st b~ pm'vied,
l~omplcte applicatioes will not be processed,
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to hspeot/on Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencin/work without permit(s) will result in f~es be/ag doubt~ or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor particit~attn~ in the Perm, it fee Account System and have &d~quate funds, check here
if you want this orocessed through your account ~
CH~CK gn ALL APPLICABLE
USE CATEGORY
~Single Family r'lDuplex CIMulti-Family [3Rental
[3Commercial
[3Industrial
FUEL E~GuS ~Eleclric rlSolid SYSTEM
EIOil . Cl$olar
DNew
TYPE
-~Forced A/r I-1Radiant []Steam 0~A/C []Vent 71Elecmc
' IS CHIMNEY BEING LINED [2No []l~e~. - LI!NrER SIZE
Note: All chiraneys shall be sized pe~ ~he BTU s being vented.
EIHot Water V1Suppl. ECon. Burner
CHiMNEY TYPE CIChinmey A rqChinmey B I~}D~rect Vent 12Other
'HEAT LOSS r'lAs Approved ~Existing FINo! Applicable
BTU RATE VIAs Per Plan I-IVariable Ii, Other Value 7~ ~ ~
DESCRIPTION OF ALL WORK BEING DONE _ ~/
VALUE (Ineluding labor and all mater/als including light fixtures) $ ~'t)
co cToa
~or applicable proj~, an ~lec~c Installation V~ficafion fo~, a~ by the ~Icc~cal Con--for, musl be
a~ched. If not aRach~ ~ not applicable, a separate Elec~cal P~I is requ~_
'FRC~'~ ~TENTH STREET STATION, INC.
FAX NO. :920-23~-0150 Jul. 07 2~83 10:18AM P4
ic tall V riff , ' ' , '.' . ":.
Electr Ins ation e cation ..
(Elec~cal Contractor~Nmn~)
' ' ' / ' t~tpcode) , .:: ·
have b.n ~n~aot~ to pe~o= el~c in*tallaffon work for~ S~ &~ ~;; ~.":'{". ::':'.''
· ' , .
atmefollow~g~dr~s: . I [ 30 ~wC& ~w~M · .7" .
fth rk m i ~ (C~ k ~ ' ~ ....
~enamreo ewe ms~o c eorDescdbe ~e a~eofwo
.... rk)
~ .~ ~o~e?on or ne~ ?emt for replac~ent Heating Pl~t ~Wor MC Cond
meoo~ecuon or n~ mm~t.for r~ont
. ' ' water heat~. -r n ~mc Wa~er ne~ or pow~ Vmted
_. _ · Reco~on of~o So. ce En~ce CaNe, MCt~ Box, ~t~a~ms to m~ptacles
. . · ~d ligh~g fix~es due to ~iding g Soffit ins~llafion. Note: New Se~ice
~m~ce Cabl~ MIl roqui~ a s~ate pmnit. '
R~fion or new c~c{fit for the l~lacement of0fl~ P~m~tl '
: ' The value' of this work is
New circuit for file additlon'ofA/C ,.. ~,- ..- J .......
· .. , ,v m. ~natvza,~at dwilli~ ullit
individual systems m a alu-l-- ' -. : .. ..... Cn · or the
eleclrical outlets v *~ or conaommmm/, including ~eq~iiri/d ~er~ic~ '
· , . . (. gn e.o Company Officer) '
. this work will be p~formed by an ·
"' "lherebyverifyl empl°yee°fthisc°mpanyandfin~her~erify.,
on / matallat~on will be done m compliance with manufacturer and Blectric code
' (Print Name of Officer) - (Date) '