HomeMy WebLinkAbout0103961 HOSHKOSH
ON THE WATER
.lob Address 1080 N WESTFIELD ST
Contractor MARX MECHANICAL
Fuel
System
Gas J ~J Oil
New ~
Forced Air
Electric
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Radiant
Hot Water
Owner EVERGREEN RETIREMENT COMM INC
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA
Heat Loss I~ As Approved
BTU Rate I~ As Per Plan
Chimney B ~) Direct Vent O Not Applicable I
~) Existing O Not Applicable I Value
~ Variable ~ Other I Value
No
Create Date
Plan
L~ Solid
103961
09/05/2003
Other
Vent J
Use/Nature
of Work
Replace furnace, 75m btu input. *EIV form from Beez Electric.
Fees: Valuation
Issued By:
$2,800.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$47.00
Date 09/05/2003
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 Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1 I30
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPI ~2aTJON u42~:
All information after bold categories mu~uf~>'~z'-,~-~,,~- 'q ~
Incomplete applicatim~ will not be proc~J feP~m~_,
' A~icati~n~s~an~fee(s~canbebr~ughtt~Ci~Ha~R~m2~5~rmai~e~t~7~i~es~P~B~x~28~
Os~osh WI 54903-1128. Commencing work without pe~t(s) will result m fees bein~d or $100.00 plus the
nomal pemait fee, which ever is ~eater.
OR
;[pou are a contracWr participatin~ in the Permit fee ~ccount System and have adequate funds, check here
ff ~ou want this procexsed through ~our account ~
JOB~Dm~SS t0g0 rd Nk=-dW4C'Lf3 qV
CONTRACTOR
CIIECK I~l ALL APPLICABLE
USE CATEGORY
~Single Family lqDuplex
F1Multi-Family F1Rental
[] Commercial
l'qlndustrial
FUEL
)l~Gas IZlElectric FISolid SYSTEM
ClSolar
[]New ~R.eplace
[]Other
TYPE
~;]:Forced Air FqRadiant ZlSteam []A/C I~Vent []E!ect~5c
IS (.I-1TMNEY BEING LINED [ZINc ~Zes - LI2xTER SIZE
Note: All chimneys shall be s/zed per the BTU's behag vented.
fDHot Water U1Suppl. U]Cc:~. Burner
CHIiVI'NEY TYPE
Icl:EAT LOSS
BTU RATE
[] Chimney A
[]As Approved
F1As Per Plan
[] Chirm~ey B
ElExisting
ElVariable
E]Direct Vent
tZ]Not Applicable
IZlOther Value
F1Other
DESCRIPTION OF ALL WOICK BEING DON'E ¢~>~9 [4(k~- ~q.)~X_5
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR
[] For applicable projects, an Electric Installation VeriEcation fora% signed by the Electrical Contractor, must be
attached. Ifnol: attached or not applicable, a separate Elech-icaI Pemait is required.
s/02
09/02/2003 21:53 D2023172§5 ~EEZ ELECTRIC PAGE 02
Electric Installation Verification
Beez Electric~ Inc,
521 W, 12th O~hkosh WI 54902
b~ve been contracted ~o perform ~lectric installa~on work for ~,
at the following address: 1080 N Westfield St. V'lta~e3t2L0.
The nature of the work consists of: (Check One or Describe the Nature of Wurk)
Reconnect/on or new circuit for rephccmem Heatin$ Plant and/or A/C Condenser,
Keconneetion or new drmlt for replacement Electric Water Heater,
Reconnet:tion of the Service Entrance Cable, M~er Box, ~lter~tions to r~ceptacles and
lighting fixtures due to siding / soffit installation. Note: N*w Service Entrance C~bles
will require a separate permit.
l~econnection or new circuit for other permmentty wired appliano~ / fixtures.
The value of~uhis work is $150.00
I her~oy verify this work will be performed by an employee of this company and ftmher ve~-y the
recormection / installation will be done in compliance with manut%~turer and El,ctric code
requirements,
(Signature of Company Officer)
~arv Biesitm~_