HomeMy WebLinkAbout0103136 HOSHKOSH
ON THE WATER
.lob Address 835 W LINWOOD AVE
Contractor TENTH STREET STATION INC
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 KARL E OLSEN
Category 501 - Residential-Air Conditioning
Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type IO Chimney A ~) Chimney B ~ Direct Vent O Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value
BTU Rate I~ As Per Plan ~) Variable ~ Other I Value
No
Create Date
Plan
L~ Solid
103136
07/28/2003
Other J
Vent J
2 ton
Use/Nature SFR/Replace 2 ton A/C. *EIV form from Drexler Electric.
of Work
Fees: Valuation $1,200.00 Plan Approval $0.00 Permit Fee Paid $23.00
Issued By: Date 07/28/2003
Permit Voided J
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 924 OHIO STREET OSHKOSH WI 54902 -0
Telephone Number 236-8770
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.
FRO~ :TENTH STREET STATION, INC. FAX NO. :920-236-0150 Jul, 28 2~3 08:41AH P1
Ci~' ct'Os~osh
Division of Inspection Selvice~
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 2~6-$050
Fax (9110) 236-$084
HVAC PERMIT APPLICATION
All Infommlion after bold categories masl be provided.
' Incomplote applicaliom will not be processed.
Q/F-KO/H
· Applicalion(s) and fee(s) can bc brought to City Hall, Room 205 or mailed to Inspeclion Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permiT(s) will result in fees being doubled or $100.00 plus thc
normal pemU! fee, which evb is grea~er.
OR
lf~vou are a c,ontractor particip~tin~ in tie P~rmit £ec Account System a~d have adeauate funds, c~eck her,?
if you want this Drocessed througl~ Vour account [~
0L a°, am .
· com cro 7e*tWt - 7,q oN
CHECK li~ ALL APPLICABLE
~S.mCATEGORY
gle Family FlDuplex EJMulti-Family
~Rental F1Commercial nIndustrial
FUEL ~Gus ~lectric El$olid
FIOil . FISolar
TYPE
EJForced Air FIRadiant EISteam II~!a, JC
SYSTEM FINew ~lReplace
[:]Other
E]Vent [2Electric EIHot Water i-ISuppl. UICon. Burner
& MAlqUFA~
IS CraM_NEY BF_ING Lll~lgD EJNo EIYes - LIaR SIZE
Note: All chimaey~ zhall bc s~d ~r ~ B~'s berg vented.
C~M~ ~E ~Chi~ A ~Ch~ey B ~Di~c1 V~t
~AT LOSS ~As Approved ~Exis~ng ~Not Applicable
B~ ~ ~As Per PI~ ~V~able ~Other Value __
DESC~mON OF ~L WO~ BErG DO~ ~ ~ ~
VALUE (lncludiag labor and all materials including light fixtures) $~00 - b~)
zLzc rmCnL co 'a.c roa t --vTr
~l;or applicable lm'Ojema, an Eleetrlc Installation Verification forr~ signed by th* El~trical Contractor, must be
attached. If not attached or not applicable, a separat~ Electrical Permit is requital
'FRO~ :TENTH STREET STATION, INC,
FAX NO.
:920-~3G-0150
Jul. 28 2003 08:41AM P2
Electric Installation Verification
(we) _ L -rz_
(Elccirical Contractor Name)
(Cit~) (State) (Zip Code)
have b*cn contracted to perform electric installation work for_.~EAJ~ ,~'-~'t f' ~T~'x'ao,G
at the following addre~: ~Sf Lt'~/[~0 o O (Name of party contracted to)
(Address where work will be performed)
Thy nature of the work consists of.' (Cheek One or D~scribe the Nature of Work)
~ Rec°nnection or new ckcuit for replaeement Heating Plant an~or AtC Condense~.
' ~ Reeormeetion or new circuit for replacement Electric Water Heater or power vented
water heater.
-- Reconnee. fionoftheServicelintrancoCable, MeterBox, alterationstoreeeptacles
and lighting fixtures due to siding/soffit installation. Note: New Service
Entrance Cables will require a separate permit.
~ Reconncction or new circuit for the replacement of other permancmly 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 s6i-vice"
electrical outlets.
__ Other
The value ofthls work is $~ 7/), ~
I hereby verify'this work will be performed by an employee of this company and further verify
the r.econnection / installation will be done in compliance with manufacturer and Electric code
reqmrement~.
( 'gn r of Company Offic~'r) '
(Print Name of OffiCer)
$/02