HomeMy WebLinkAbout0099072-HVAC (furnace)OSHKOSH
ON THE WATER
,Job Address 843 W 5TH AVE
Contractor TENTH STREET STATION INC
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner DONALD E BASLER
Category 500- Residential-Heating & Ventilating
Electric
Replace
Steam
Suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved O Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
99072
12/13/2002
Other J
Vent J
75m
Use/Nature SFR/Replace furnace. *EIV form from Drexler Electric.
of Work
Fees: Valuation
Issued By:
$1,875.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$33.50
Date 12/13/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 924 OHIO STREET OSHKOSH WI 54902 -0
Telephone Number
236-8770
12/11/2882
23:88
9282368158
TENTHSTREETSTATION
PAGE 81
ion Services
HVAC PERMIT APPLICATION
All inlbrmation after bold catc§orie$ must be provided.
Incomplete upphc:mons will r)ot be processed.
)
'd
) and foe(s) can be brought to Ci.ty Hall, Room 205 or mailed to Inspection Services, ?O Box 1128,
54903-1128. Commencirxg work without pe~it(s) will resul~ in fees ~ing doubled or $100,00 plus the
~t fc~-, which ever is
)R
troctor ~ar[Jcit)~J~.~ in t,,e Perttt~'t fee ~ccikttt~t Sy~.~.em q~ ~ave a~uat~ I~t,ld~, check here
processed th~a~.g~ ,¥ottr
, Al'PlACABLE
y
F'lMulti-Farnily r'lRental OCommercial Olndustrial
UIElectric EJSolid SYSTEM ~New [Ii[Replace
OSolar OOther
lR::diam IDSteam ClAYC ElVent OElecmc Elliot Water EISuppI. OCon, Burner
RING LINED ONo I~Yes - LINER SIZE ~' r~t & MA~AC~R ~t~
sh,.ll be sized per ~e Bq"u'S being vented,
E ~Chi:~cy A ~Chi~ey B ~Direct Vent ~her
~A$ ~pproved ~Existiag ~Not Applicable
~As I'~Plan OVanable ~Other Value 9~
,4
tic.,.ble projects, :in I);lectric Installation Verification fi>ma, signed by the Electrical Contractor, must be
l i",.ot attached or not applicable, a separale Electrical Permit is required.
~/02
12/11/2882
23:00
92023B0150
TENTHSTREETSTATION
PAGE
02
Electric Installation Verification
(We)_ _
(Electrical Contractor Name)
(Ad~e~) (Ciw) (State) (Zip Code~
have been contracted to p~fo~ elec~c ~stalladon work for ~~ g~ $~~
~o ofp~y conffacted to)
at the following ad,ess: ~q5 ~; F~ ~
(Ad~s wher~ wor~ will b~ perfo~ed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
.~ Reconnection or new circuit for replacement Heating Plant and/or AffC Condenser.
Re. connection or new circuit for replacement Electric Water Heater or power vented
'water heater.
~ Reeonnection 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 $ ,/fi. g9. e~0
I hereby verify'this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
(Print N~Lme of Officer)
(Date)