HomeMy WebLinkAbout0103859-HVAC (boiler)OSHKOSH
ON THE WATER
.lob Address 1051 VAN BUREN AVE
Contractor VANS HEATING & A/C INC
Fuel
System
Gas J ~J Oil
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Owner GENE B LANGLITZ
Category 500- Residential-Heating & Ventilating
L~ 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
103859
09/02/2003
Other ]
Vent
Use/Nature SFR/Replace boiler. *EIV form from Concept Services.
of Work
Fees: Valuation
Issued By:
$4,549.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$74.00
Date 09/02/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 525 BUTLER ST DEPERE WI 54115 -5426 Telephone Number
(920) 336-2816
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
FROM
FAX NO. :
May. 05 ~01 12:58PM P~2
CiW of Oshkosh
Division of lusp¢cfion Services
P.O, Box 1130
O,s~osh, WI 54903-1
Phone (920) 236-5050
]Fax (920) 236-5084
HVAC PERMIT APPLICATION
Ail information after bold categories must be provided.
Incomplete application$ will not be proceeded.
Application(a) 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 $100.00 plus the
normal permit fcc, which ever is greater.
OR
If you are a contractor oartictoa. L~n~ in tile Permit fee dceDu*lt System and have adeq~tate funds, check here
if you want t~i$ t~rocessed tl~rou~ your account
n -
OATE
CHECK I~ ALI, APPLICABLE
~,~E CATEGORY
~ingle Family r'lDuplox ElMulti-Family f-IRcntal [3Commercial Ullndustrial
FUEl, ~Ga$ nElectrie DSolid SYSTEM
OOil ~Solar I-lather
TYPE
F1Forced Air [3Radiam [3Steam OA/C IZ}Vent ~Eleotr/c~l~flot Water r-lSuppl.nCon. Burner
IS CIIIMNEY I~EING LINED'~o ["lyes - LINER SIZE & MANUFACTUR.ER
Not~: All chinmeya shall be sized pm' the BTU's being vented.
CHIMNEY TYPE ElChimney A uIChimney B ElDirect Vent EIOther
HEAT LOSS QAs Approved VIg:xisting V1Not Applicable
BTU RATE [3As Per Plan FIVariable OOther Value
DESCRIPTION OF ALL WORK BEING DONE~ ~)[a Cl FLO/ ~)O, LO_~4. ,
,~0
VALlLTE(ln,ludinglaborandallmat,rial, ln¢lu~in~li,htfixture$)$ qSqq O0
ELECT~CAL CON~CTOR ........ 0R ~ glo,tlc Instal~tlon Verification form attache~lf Rcpla~,0
· FROM :
FROM : cnNC~PT SERVI
FAX NO. :
I~AX NO. ~20
M~W. 05 201~1 12:51~PM P1/2
Mar. 18 200~ 03:01PM P1
Electric Installation Verification
I (Wo)
(Aa~s) (CiW) (State) (Zip Code)
h~cbc~ct~to~o~c~t~atlon~rk~Or ~ ~,~
(~fo~ wh~ wo~ will be p~o~ed)
The nmure o£the work cons/~s of: (Cho~.k One or Descr/be Ib.~ Naturo of Work}
..~ Rccorm~ction or now ~itcult for replao~ne~t H~g P~t ~or ~C Cond~.
R~o~fion or now c~t for ~la~t ~l~c Wa~ H~ or ~ v~t~
~ hcat~.
~n~cc C~]~ ~ll ~ a s~ p~it.
.. R~a~ ~ n~ c~u~t for t~ replac~t of o~ p~tly m~
~ N~ ciw~t f~ ~ ~fion of ~C to m ~l d~tng ~tt ~ou~ or the
~i~du~ ~ ~ ~ d~l~ ~ ~d~;~), ~luding ~u~ s~ce
ol~c~ ~.
~h~
Tho value of this work is S :~O(::).C~:::) .
-I hereby verify this work will be performed by an employee of this company and further verify
thc r~connection I installation will be done in e, omplianoo wi~h manufacturer md Illectfic code
d 2;b/?o v .
(Sili~ature of Company Of'licer) · ('Print Name of Officer) (Dart:)