HomeMy WebLinkAbout0102668-HVAC (a/c)(~ CITY OF OSHKOSH
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2720 HAMILTON ST Owner CARLA J BASILIERE
Contractor AMERICAN HEATING & A C CO Category 501 - Residential-Air Conditioning
Fuel ~J Gas J ~J Oil b~ Electric ~J Solar
System ~J New ~ ~J Replace ~ ~J Other
~J Forced Air I ~J Radiant L~ Steam ~J A/C
~J Electric I ~J Hot Water b~ suppl. ~J Con. Burner
Chimney Type I~ Chimney A ~ Chimney B ~ Direct Vent O Not Applicable I
Heat Loss I~ As Approved ~ Existing O Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 24m A/C
No
Create Date
Plan
~J Solid
Vent
102668
07/07/2003
Use/Nature SFR/Install 2 ton central A/C. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$1,500.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$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.
Signature
Date
Agent/Owner
Address 1129 MICHIGAN AVE OSHKOSH WI 54902 -6437 Telephone Number
(920) 235-8090
~- City of Oshkosh
Division of Inspection Services
P.O. Box ! 130
Oshkosh, WI $4903-1130
Phone (920) 236-5050
Fax (920) 236-5084
JUL 0 7 ' Ou7
O/HKO/H
HVAC PERMIT APPLICA LOPME T
All infomtion after bold categories must be provided.
Incomplete applications will 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 xvithout permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
lf ¥ou are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account
CONTRACTOR
DATE
CHECK [] ALL APPLICABLE
USE CATEGORY
[~$ingle Family [3Duplex UlMulti-Family
F1Rental [3Commercial [3Industrial
FUEL J~3as E]Electric VISolid SYSTEM Ji~,New I-IReplace
FlOil [21Solar [-IOther
TYPE
UlForced
t[~k/C F1Vent [-IElectric Flttot Water FISuppl. FlCon. Burner
Air
IDRadiant
ElSteam
IS CHIMNEY BEING LINED ~qo F1Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE rqChirnney A ElChimney B ElDirect Vent .l~Other
HEAT LOSS I-lAs Approved [3Existing E~t Applicable
BTU RATE I-lAs Per Plan V1Variable [$gQther Value
DESCRIPXION oF ALL WORK BEING DONE
VALU'E (Including labor and all materials including light fixtures) ~; /.~"~D ~'
ELECTRICAL CONTRACTOR OR [] Electric Installation Verification form attached(If Replacemem)
Electrical installation of new/replacement equipment sfiall be done by licensed contractors.
3/02
Electric Installation Verification
(EI~o~ Conjuror Nme)
~Ad&~) (City) (Stat~) (Zip CoaO
have Deen ~n~actea to pe~o~ elec~e installation work for ~/C~ ~ ~ ,
atth followingad =s: E 7&
(Ad&e~ where work will ~ ~ffo~)
The nature of the work consists off (Check One or Der, cribe the Nature of Work)
_~ Reconnection or new circuit for replaceraent Heating Plant and/or A/C Condenser.
__ 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 r~luire a separate permit.
Reconnection 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 (house or the
individual systems in a duplex or condominium), including required s~rvice
electrical outlets.
~ Other
The value of this work is $
I hereby verify this work will be p~rformed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufactur~ and Electric code
requirements.
(Print Name of Officer)
(Date)
5/O2