HomeMy WebLinkAbout0102896-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
1806 WINCHESTER AVE
ALL SEASONS QUALITY HTG & CLG
Job Address
Contractor
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner MR/MRS JOSEPH C LANGKAU
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved O Existing
BTU Rate I~ As Per Plan O Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
102896
07/17/2003
Other
Vent J
Use/Nature SFR/Furnace & A/C replacement job. *EIV form from Drexler Electric.
of Work
Fees: Valuation
Issued By:
$3,420.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$57.50
Date 07/17/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1661 IOWA ST OSHKOSH WI 54902 -0
Telephone Number
(920) 426-8090
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, VII 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
O/HKO/H
HVAC PERMIT APPLICATION
All information 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 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
if you wont this processed through your account
OW R 277 r/l -k 9/co ct.
CONTRACTOR All
CHECK [] ALL APPLICABLE
USE CATEGORY
/~Singte Family V1Duplex
V1Multi-Family V1Rental
V1Commercial
[3Industrial
FUEL ~_~as [3Electric V1Solid SYSTEM F1New ~eplace
[2Oil [DSolar VIOther
'TYPE
~l~orced Air U1Radiant [~Steam XA/C []Vent []Electric
IS CHIMNEY BEING LINED F1Ncc~es - LINER SIZE ~
Note: All chimneys shall be sized per the BTU's being vented.
V1Hot Water E1Suppl.
& MANUFACTURER
EICon. Burner
CHIMN'EY TYPE
HEAT LOSS
BTU RATE
VIChimney A
mAs Approved
IDAs Per Plan
V1Chimney B
~xisting
E~[Variable
~irect Vent
VINot Applicable
[]Other Value
[]Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials including light fixtures) ~
ELECTRICAL CONTRACTOR %~.~\.-¢~ ~ie&(O~,~ c'"'.L~C.. .
151 For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, most be
attached. If not attached or not applicable, a separate Electrical Permit is required.
Electric Installation Verification
I(We) Etc..
(Electrical Contractor Nmxqe)
' (Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for ~_,
(Name of party cm'~acted t~-
at the following address: l
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
. ~'~ecormection or new circuit for replacement Heating Plant and/or A/C Condenser
__ Reconnect(on or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnect(on 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.
Reco~mection or new circuit for the replacement of other permanently wired
appliances / fixtures.
~'~ New circtfit for the addition of A/C to an individual dwelling unit (house or the
individual systems in a duplex or condommium), including required service
electrical outlets.
Other
The value of this workis $_ ~ - c_,_3
I hereby verify this work will be perfo~aed by an employee of this company and further verify
the reconnect(on / installation will be done m compliance with manufacturer and Electric code
requirements
(Print Name of Officer)
'7 -oB
(Date)
5/02