HomeMy WebLinkAbout83035-HVAC � CITY OF OSHKOSH No ooasoss
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 280 W 35TH AVE Owner COMPETITION PRODUCTS Create Date 1'I/21/2000
Contractor CONKLIN SHEET METAL INC Category 512-Ind.&Comm-Both Plan
Fuel �✓��Ga� Oil � Eleciric [ Solar Solid
. System [' New , _J � Replace i � Other
✓� Forced Av Radiant � Steam ✓ A/C Vent �
C— —� � � �� �
� Electric Hot Water Suppl. I i Con. Bumer
Chimney Type Chimney A Chimney B Direct Vent Not Applicable
Heat Loss �As Approved Existing Not Applicable Value
BTU Rate �As Per Plan Variable Other Value
Use/Nature Instail HVAC in addition. Heating and A/C I
of Work I
�
I
. Fees: Valuation $12,000.00 Plan Approval $0.00 Permit Fee Paid $'175.00
Issued By: � Date �1/21l2000
� � Permit Voided i
In the performance of this work, I agree to pertorm all work pursuant to rules governing the described construction.
Signature Date
AgenUOwner
Address 5060 KENWOOD CT OSHKOSH WI 54904 -0 Telephone Number 231-3744
` ComQiiance Statement
This form a reqwred ro be subm�aed by the supervising proiessional farehicect, engmeer. HVAC desiv,ner or decmcal demgnen
observmg consmtcnon ot pro�ecss w�chin buddings w�ch to[al areas exceeding �0A00 cubic feee and consuucnon of antennys, towers,
and bleachers i ILHR�0.f 0l. Faiiure m subm�c this farm may result m pena�nes as speci[ied in ILHR�0.:6 and/or local ardinances.
Gnneral Instructions: Prior to che initiai occupancy of new buiidings or addicions znd the final occupancy of altered
exisnng buiidings, submic this compleced and signed fartn [o:
• The municipal buiiding inspection o�ce and
• Saiecy and Buildings. P.O. Box 7969, �tadison. WI :3707-7969
Personal inlortnanon you provide may be used for secondary pufvoses(Pnvacy Law. s. I5.041 i)(mi�. .
1. PROJECT INFORMATION: (Use che Safecy and Buildings or municipa! project labei, or rype or print the
intormacion. [f labei is used. no additional enw is needed on P�rt l.
Owner Informarion Pro�ecs Information
L Name BwlCing JccuOd+ry�aPtent)de Use
A I 64�54 0f£ice/Warehouse
Company Name Tenan[Name Ut any)
B Competition Products, Inc. I Valve Train Only
E NumoeranOSUeet 8widingLocauonlnumoadcsueetl
L 280 W. 35th Ave. 280 W. 35th Ave. �
Cin L Ciry �_ Village u Tawn of Cow.ry oi
Oshkosh Oshkosh Winneba o
H Suta anC Zip Code p'operty idenuticauon Numoa
$ WI 54901 Site 168175
R Ptan or Re�eRnce Numoer Name&Reg.M of Supavrsing Prot for�Buiiding �_HVAC �Li�Os
E 44zz63 -
Neme&Reg.%of Supav�sing Prot.for_Building�FIVAC ._Lighung Name&Req.A o[Sucervuing PmL for�Building �FNAC :Lig6tmg
Michael Leberfing 1505-007
2. PURPOSE OF THIS STATEI'[E�('T: (Check Box A, B. C, or D co indicace purpose and compleu any ocher applicable
boxes and infarmarion. .4ttach addicional pages if necessary.)
Checic chose which aopiy: C Building � HVAC = Lighring (
= Paniai Complenon - .
Descriouon ai Portion Ca�.�Qiemd
A) C Statement of Substantial Compiiance
To ihe besc oi my knowiedge.be(ier;and based on onsi[e obseradon,construc:ion oi Ne?ollowing building and/or HVAC itans
aoplicable ro Nis projecc have been comaieced in suosiannal compliance with dte aoproved oians and specit3w[ions.
� BUILDfiYG ITE.l1S XX HVAC ITEA15
I. Swctural rystem inctuding submiQal and aec[ion oPall building componrnts I. HVAC sys[em including iinai ttst
(muses.prcc� meral building,ttc) ([LHR CrI.S)
2 Fire pro[ettion rys[ems(sprinklecs.aiazms,smoke deuccorsl daigned, ?. All condi[ions ot HVAC plan approval and
inmlled and msied(including ionvard flow on bacic flow devices)by applicable variances
approoriazely reginered proiasionals
3. Shaz't and stainvay enclosure = LIGHTING ITEMS
� 4. Exia inciuding exit and direczional tighu I. Ex[erior lightlng&con¢ol requiremrncs
5. Firc-resistive consvuc[ioa enclosurc ot hazuds,firo wails, la6eted doors.clus ?. [n[erior lighting&conrml reauircmrna
of conswction 3. All conditions oi ligh[ing pian approvat and
6. Sanimtion ryscem(toilecs.sinks,drinking iacili[ia) and appiicabte vanances
7. ILHR ba[ria-tree requiraarnes -
8. All condidons oi buiiding plan approva{and applicable varianca
The foilowinq itema are noi in complianee and must be addreseed: Testing and balancing p2r Com 64�53
B) ❑ Statement of Yoncompiiance
Due to che iollowing listed violazions,rhis project is not rad,v for occupancy:
C� G SuQervising Professiona(Withdrawn From Project (Use�B above co indicate projecc stants as or this da[e.j
D) G Projec2:lbandoned �
3. SUPERVISING PROFESSIONAL SI�G�Ii�TLJ E�FqOR:
_' Building�E7CHVAC _ Ligh[ing i/ �i/. _ ��1��!.� --'�� � Daze January 9 2002 �
� " �-,�•
�_ BuilCing _ HVAC _ Ligh[ing Da[e
�: Building _fiVAC _ Lighnng Date
SHDB-9720(R.01/97) ,
BADGER METALS, INC. •
- ` P.O BOX 1034 • 911 S. LYNNDALE
APPLETON, WISCONSIN 54912
PHONE (920) 739-7391 ❑ URGENT-REPLYIMMEDIATELY
� � FAX (920) 739-0474 � ,� NO REPLY RE�UIRED
. �
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I SIGNED DATE
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