HomeMy WebLinkAbout2003-HVAC (a/c)OSHKOSH
ON THE WATER
JobAddres$ 1811 S MAIN ST
Contractor MARX MECHANICAL
Fuel
System
Gas J ~J Oil
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Owner FOSTER H POKRANDT
Category 501 - Residential-Air Conditioning
Electric
New ] ~ Replace ]
Forced Air ] ~ Radiant
Electric I ~J Hot Water
L~ Steam
L~ suppl.
Solar
A/C
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
No
Create Date
Plan
~ Solid
103754
08/27/2003
Other ]
Vent
Use/Nature SFR/Install Central A/C. *EIV form from Beez Electric.
of Work
Fees: Valuation
Issued By:
$1,546.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$29.00
Date 08/27/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 4535 STATE ROAD 91 OSHKOSH WI 54904 -6304 Telephone Number
(920) 235-6510
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 Osl~osh
Division of InsPection Services
P.O. Box 1130
Oskkosh, WI 54903: l 130
Pl{on~ (920) 236-5'650
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete application, s will not be processed.
O/HKO/H
· 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 perrmt(s) will result in fees being doubled or $100.00 plus the
normal pem~it fee, which ever !s greater.
OR
lf 3, ou are a contractor parIicipatin~, in the Permi! fee ,~ccount S3~stem and have adequate funds, check here
i[~ou want this processed through ~our acc•un!
CONTRACTOR ~'~ ~-.
CIIECK ~ ALL APPLICABLE
USE CATEGORY
l~Single Fmnily [3Duplex [3Multi-Fmnily
nRental I-1Commercial [3Industrial
FUEL []Gas ~Electric []Solid SYSTEM ~New []Replace
[3 Oil [] Solar []Other
•Forced Air ~Radiant []Steam ~i.A/C []Vent []Electric ~ttot Water []Suppl. []Con. Burner
IS CI]IiVINEY BEING LINED [~No EYes - LINER SIZE
Note: Alt chinn~eys shall be sized per the BTU's being vented.
& MANUFACTURER~
CttlM2N~EY TYPE
II]EAT LOSS
BTU RATE
~Chinmey A
~As Approved
[]As Per Plan
[] Chinn*ey B
[] Exi sting
~Vmiable
[]Direct Vent
[]Not Applicable
[3Other Value
[]Other
DESCR1 TION OF Al ~. V, OllK BLING DONE
VALUE (Including labor and all n,mterials including light fixtures) $~ ] 5 q ~ ~00
~ ~ ~] F~r app~icab~e pr~jects, an E~ectric ~nsta~ati~n Veri~cati~n f~rm~ signed by the Electrica~ C~ntract~r~ nmst be
- ~ attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
08/24/2009 22:28 92023/7255 BEEZ ELECTRIC PA6E
Electric Installation Verification
Or) (We) Beez Elec~d¢, Inc.
$21 W. I2th O~hko.~h WI 54902
have been contracted to perform electric installation work for Marx
fo]lowing address: 18;[1 S Main Street
The nature of the work consists of: (Check One or Describe the Nature o~'Work)
[] Itrcon~ection or new circuit for replacement HeaQn~ Plant and/or A/C Condenser.
[] ' Recormection or nc~v drcuit for replacement Electric Water Heater.
[] tl,econnention of the Service Entrance C~ble, Meter Box, slterations to receptacles snd
li~hfutg fixtures due to siding / soffit in~tsllation, Note: New Service Entrance Cables
will require a svCarate permit,
[] R.econnection or n~v circuit for other permanently wired appliances / fi~c-,res.
[] other
The v01ue ofthii work is $150.00
I hereby verify thi~ work will be performed by an employe~ of this company and Purther verify the
reconncetion / installation will be done in cornplianv¢ with ~nuf~cturer and Elecuic code
requirements,
($i~ture of' Company Office0