HomeMy WebLinkAbout0103975-HVAC (furnace)OSHKOSH
ON THE WATER
.lob Address 512 DAKOTA ST
Contractor DRUCK'S PLBG & HTG & CLG
Fuel [~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Owner FREDERICK E SCHRAUTH REV TRUST
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
Forced Air I ~J Radiant
Electric I ~J Hot Water
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type IO 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
L~ Solid
103975
09/05/2003
Other
Vent J
Use/Nature SFR/Replace furnace. *EIV form from Heritage Electric.
of Work
Fees: Valuation
Issued By:
$3,000.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$50.00
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 504 3RD ST P O BOX 355 MENASHA WI 54952 - 0 Telephone Number
(920) 426-2654
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.
P.o. ,,3° SEP 0 5
Oskkosh, w~ s4903-1130
~AC PERMIT APPLICATION
All fields/i~fomatio~ after bold categories must be provided. '"~
I~com91ete agBlicatio~s will ~ot be
DATE 9-3-03
JOB ADDRESS
512 Dakota St
OWNER
CONTRACTOR
Fred Schrauth
Drucks
CIRCLE ALL APPLICABLE
USE CATEGOR~--~ S INGLE FAMILY DUPLEX
FUEL ~/ ~ OIL ~ECTRIC
SYSTEM NEW
TYPE ~ RADIANT
ELECTRIC HOT WATER
IS CHIMATEY BEING LINED LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
CHIMITEY TYPE CHIMNEY A CHIMNEY B
MULTI-FAMILY
SOLAR
OTHER
STEAM A/C
SUPPL.
HEAT LOSS
AS APPROVED
EXISTING
COMMERCIAL
SOLID
VENT
CON. BURNER
MANUFACTURER
INDUSTRIAL
DIRECT VENT
NOT APPLICABLE
OTHER VALUE
BTU RATE AS PER PLAN VARIABLE
NATURE OF WORK: ~,~'
.VALUE (InclUding iabor~t 3000.00
ELECTRICAL CONTRACTOR
Electrical installation of new/replacement equipment shall be done by licensed
contractors.
OTHER
Valuation Fees 5o
$0 to $1,000.00 ......................................................................................................... $20.00
$1,000.01 to $10,000.00 ..................................................................................... $20.00 for first
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10,000.01 to $25,000.00 ................................................................................... $155.00 for first
$10,000.00 plus $1.00 per $100.00 valuation or part thereof
Over $25,000.00 ........................................................................................................... $305.00 plus $0.50
per $100.00 valuation or part thereof
· Submit payment with application. Failure to pay within 30 days will result in
fees being, doubled or $100.00 plus the normal permit fee, which ever is
greater.
/Nm of par~y corm*a~d to)
work l er ormed)
(Check One or I~cr~b~ ~g Nm c~ Work)
~' P*~connec~ion or new ci~uit for replsceme~
R~emJon or new c~it ~or ~l~mem
~ec~n O~e $~cc ~ce
~g fi~ due to ~g / ~t ~o~
I hereby verify this work will be performed by m e~ployee of~is Company and fu~hcr vcri~y thc
te~ozm~ction / iestallition will be done ia compliar~e with mamifactun~ and ~lec~ic code
te~u4t~mcnts.
(Si~natUr~ &fCor~ Officer)
(Print Name of Officer)