HomeMy WebLinkAbout0102640 H(~ CITY OF OSHKOSH No
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
JobAddress 1820 MITCHELL ST Owner JAMES/KIMBERLY DREWS
Contractor AMERICAN HEATING & A C CO Category 502- Residential-Both
Fuel ~J Gas ~ ~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 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 50m & 24m A/C
102640
Create Date 07/03/2003
Plan
~J Solid
Vent
Use/Nature SFR/Replace 50m btu furnace and add 2 ton central A/C. *EIV form from Seckar Electric.
of Work
Fees: Valuation $3,900.00 Plan Approval $0.00 Permit Fee Paid $83.50
Issued By: Date 07/03/2003
Permit Voided
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 1130
Oshkosh, WI 54903-I 130
Phone (920) 236-5050
Fax (920) 236-5084
JUL 0 OZHKOjH
HVAC p E RM IT Ap Till
All infomtion after bold categories
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 without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
i£¥ou want this processed through your account F~
DATE
,O. ADD" SS
OWNER
CHECK gl ALL APPLICABLE
USE CATEGORY
[;~ingle Family I--1Duptex F1Multi-Family FIIndustrial
F1Rental
F1Commercial
FUEL ~Oils FIElectric FISolid SYSTEM FINew ~[~eplace
FISolar V1Other
TYPE
~orced J~/C UIVent I-tHot Water ViSuppl. F1Con. Burner
Air
F1Radiant
F1Steam
ViElectric
IS CHIMNEY BEING LINED VINo [j~Xes - LINER SIZE ..~_'~__ & MANUFACTURER
Note: All chimneys shall be sized per the BT[?s being vented.
CHIMNEY TYPE UlChimney A F1Chimney B ~irect Vent VIOther
HEAT LOSS I-lAs Approved '~c~isting IZlNot Applicable
BTU RATE [Z]As Per Plan ViVariable ~her Value
DESCRIPTION OF ALL WORK BEING DONE /~C~:~//g~'e ~..~
VALUE (Including labor and all materials including light fixtures) _$~__ ~t~ 0'~
ELECTRICAL CONTRACTOR OR JL~Electric Installation Verification form attached(If Replacement)
Electrical' 'installation of new/replacement equipment shall be done by licensed contractors.
~/o2
Electric Installation Verification
CoPtP/t J
(Elec~c~ Con~ctor N~e)
(Ad.ess) (City) (State) (Zip Code)
have been eon~acted m p~o~ electric installation work for ~/C~ [~ ~ ,
~e ofp~y eon~et~ to)
at the follow~g ad~e~: .~f~
(Ad~e~ where work ~11 be ~ffo~ed)
~e m~ of~e wo~ eonsis~ off (Ch~k One or D~fi~ ~e Na~e of Wo~)
~ R~o~eefion or new circuit for r~la~ent Hm~g Pl~t ~or ~C Cond~.
.... Rem~fion or new circ~t ~br r~l~em~t El~c Water H~t~ or pow~ vent~
wat~ heat~.
~ R~tion of~e Semite Entree C~le, Metor Box, ~t~fiom m ~taeles
~d li~fing fixt~ due m s~ng / soffit ~l~fion. Note: New S~ee
EnCee Cabl~ will require a ~mte p,mdt.
~ Re~tion or n~ circuit for ~e r~lae~ent of o~er p~mtly wk~
~lmces / fixt~es
New cim~t for the addition of~C m ~ individuhl ~elling unit (ho~e or ~e
individufl systms in a duplex or co~omini~), including r~uk~ s~iee
el~efl outlets.
Omer
The value of this work is $,
I hereby verify this work will be performed by an employee oft}ds company and further verify
the recormection / installation will be done in compliance with manufacturer and Electric code
requirements.
(~ignatu~e of Company Officer)
(Print Name of Officer)
(Date)
5t~2