HomeMy WebLinkAbout0103072-HVAC a/c) CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
OSHKOSH
ON THE WATER
Job Address 622 BOWEN ST
Contractor ADONIS HEATING AND COOLING
Fuel IVl Gas I I IOil I
system ~ New ~
~ Forced Air I ~j Radiant I
U Electric I [] HotWater ~ I IsuppI'
Owner WILLIAM/JULIANN PARKIN
Category 50f - Residential-Air Conditioning
[~ Electric [] Solar
[] Replace I
~ Steam L~J NC
Chimney Type
Heat Loss
BTU Rate
No 103072
Create Date 07/24/2003
Plan
1 [] Solid 1
[] Other I
j ~ Vent j
Con. Burner I
~ ChimneyA (,,~ ChimneyB (~ DirectVent O Not Appliceble I
~ As Approved ~.~ Existing O Not Applicable I Value
~.~ As Per Plan ~, ~ Variable ~ Other I Value
Use/Nature fBFPJ Install new central air conditioner. *EIV form from Seckar Electric.
of Work
l
Fees: Valuation $1,500.00 Plan Approval $0.00 Permit Fee Paid $27.50
Issued By: ,~ ~/~ Date 07/24/2003
j - [] Permit Voided J
In the per~orm~/~ce of thi~ork, I agr~edorm'a~ ~ ~-J ' scribed construction.
Signature ~ //~'~'~ /~--~/~//'~~ Date~ ~ ~ ~;
Address W2~ Coun~ Rd H Pine River WI ~965 - 0 Telephone Number 68~0458
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
O/HKO/H
ON THE WATER
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,
Oshkosl~ 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
Il'you are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account [~
,OB /27 gC
DATE
CIIECK [] ALL APPLICABLE
USE CATEGORY
/~ingle Family FIRental
FUEL s SYSTEM
[~Oil
TYPE a~
ZlForced Air FIRadiant F1Ste Vent i-lElectric
IS CHIMI~Y BEING LINED FI~. LINER SIZE
Note: All chinmeys shall be s/zed per the BTU's being vented.
FIDuplex []Multi-Family
12Electric lDSolid
I:]Solar
[2]Commercial
IZlOther
V1Hot Water nSuppl.
& MANUFACTURER
[]Industrial
I-IReplace
F1Con. Burner
CHIMNEY TYPE
HEAT LOSS
BTU RATE
F1Chimney A
[~As Approved
I-lAs Per Plan
r"lChimney B
F1Existing
[ZlVariabte
F1Direct Vent
I-INot Applicable
r~Other Value
FIOther
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials inel.ding light fixtures) $
ELECTRICAL CONTRACTOR $ ~_.C ~C
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
City of Oshkosh
Division of lrapecfion Services
215 Church Avenue
PO Box 1130
Electric Installation Verification
(we)
(Electrical Contractor Name)
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for ~V)O~4)~ ~4~-/ac'D~M~
(Name of party contracted to)
at the following address: ~,~- 5(ff, tTEOq
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
X/(f. Recormection or new circuit for replacement 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 require 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 service
electrical outlets.
Other
The value of this work is $
I hereby verify this work will be performed by an employee of this company and fm~er verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
( S igll!Ul{ e~o~'~r~m pan y~ fticer)
(Print Name of Officer) (Date)
5/02