HomeMy WebLinkAbout0102760-HVACOSHKOSH
ON THE WATER
.lob Address 875 W 19TH AVE
Contractor CUSTOM HEATING & COOLING
Fuel ~ Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Forced Air
Electric
Oil
Radiant
Hot Water
Owner GEORGE/NADINE SIEBER
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA
Heat Loss I~ As Approved
BTU Rate I~ As Per Plan
Chimney B
~ Existing
~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
102760
07/11/2003
Other
Vent J
Use/Nature
of Work
Install 3 heat ducts to new 18' x 24' Family room addition on the rear of the house.
Fees: Valuation
Issued By:
$500.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$20.00
Date 07/11/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1503 SOUTH MAIN STREET OSHKOSH WI 54902 -0
Telephone Number
(920) 235-7263
City of Oshkosh
Division of Impcction Services '
P.O. Box 1130 ~',,f~ .d'~, ~ ~ }
Os~osh, WI 54903-1130 ~/z ~ff~ ~/
Phone (920) 236-5050
( 20) 236-50 4
HVAC
All infomfion after bold categories mu~ro~d.
Inco~lete applicafiom will not be proce~
· Application(s) ~d fee(s) c~ be brought to CiW Hall, Room 205 or ~iled to ~specfion S~ces, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without penuit(s) w/Il 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 fee Account SFstem and have adequate futnds, check here
if vou want thisprocessedthrough vour account~_~ [-]/r~ DATE 7/~/~! !'~
JOB, D=SS
USE CATEGORY
~3ingle Family F1Duplex ElMulti-FamiIy
[2Rental [2]Commercial Fllndustfial
FUEL []Gas F1Electric F1Solid SYSTEM I~New []Replace
[]Oil F1Solar V1Other
TYPE
UIForced Air F1Radiant F1Steam []A/C FlVent []Electric []Hot Water FISuppl. []Con. Burner
IS CIq-EVlNEY BEING LINED []No I-lyes - LINER SIZE
Note: All chimneys slmll be sized per the BTU's being ~ented.
& MANUFACTURER
CHIMNEY TYPE
I~AT LOSS
BTU RATE
[]Chimney A
I-IAs Approved
[]As Per Plan
[]Chimney B
F1Existing
[]Variable
DESCRIPTION OF ALL WORK BEING DONE
[]Direct Vent
[]Not Applicable
[]Other Value
F1Other
VALUE (Including labor and all materials including light fixtures) $ .~d~ ~
ELECTRICAL CONTRACTOR
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Conlractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/o2