HomeMy WebLinkAbout0098794-HVAC (boiler) CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
OSHKOSH
ON THE WATER
Job Address 1355 CAMBRIDGE AVE
Contractor E C MERRILL INC
Fuel [~--G-~s 1 ~ Oil
System [] New I
~ Forced Air I ~ Radiant
[] Electric ] L~ Hot Water
Owner JOSEPH F SCHIRGER
Category 500- Residential-Heating & Ventilating
[] Electric
[] Replace
~ Steam
[] Suppl.
~j Solar
L_I Nc
Con. Burner I
Chimney Type ~ Chimney A ~ Chimney B ~.~ Direct Vent ~ Not Applicable I
Heat Loss ~ As Approved ~ Existing ~ Not Applicable I Value
BTU Rate ~ As Per Plan (~ Variable ~ Other I Value
No 98794
Create Date 11/25/2002
Plan
[] Solid
[] Other
L-J Vent
102m
Use/Nature SFP,/Replace boiler. *EIV form from Witzke Electric.
of Work
Fees: Valuation
Issued By:
$3,400.00 Plan Approval $0.00 Permit Fee Paid
[] Permit Voided
$56.00
Date 11/25/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 804 WITZEL AVE OSHKOSH WI 54902 -5710 Telephone Number
(920) 235-3600
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
ON T~E VIAT~R
HVAC PERMIT APPLi~~~ O[ _ ._
.]] i~o~o~ ~a~r ~o~d ~a~go~ mg~[~~L0?g[U ~
Inco~lete applicafio~ M~~[~e~ ~' ~
Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Service.s, 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 fee, which ever is greater.
OR
I£ vou are a contractor participating in the Permit ieee Account System and have adequate ieunds~ check here
if you want this processed through your account
JoB ~DDa~SS
OWNER
DATE
CONTRACTOR
C1TECK [] ALL APPLICABLE
USE CATEGORY
I~:Single Family I-1Duplex
I-'lMulti-Family
I-IRental F'lCommercial l'-tlndustrial
FUEL l~Jas F1Electric E]Solid SYSTEM l"INew l"lReplace
FIOil I-1Solar F10:ther
TYPE
F1Forced Air F1Radiant nSteam DA/C F1Vent DElectric l~-Iot Water DSuppl. F1Con. Burner
IS CFIlMNEY BEING LINED i~No I-IYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
CFi~ENEY TYPE
FIE. AT LOSS
BTU RATE
~himney A
I-lAs Approved
DAs Per Plan
DESCRIPTION OF ALL WORK BEING DONE
& MANUFAC2'URER
F1Chimney B DDirect Vent BOther
,]~Existing F1Not Applicable
[]Variable ]~]Other Value ( O 7..
VALUE (Including labor and all materials including light fixtures) $ :~~'~O('d '~----~. ~ :
-~ -:' S- -
ELECTRICAL CONTRACTOR In form attached(If Replacement)
u,~. ,:x:; ,,,,"--'~, ~ ........... - .............. ; "' · shall bedone by licensed contractors.
HOV, 2~3.2~8~.' 2: 30PH NiTZKE ELKCT~IC, Iq0,878 P, 1."1
Electric Installadon Verification
(Ad~ezs) (City) (State) (Zip Code)
~me ofp~y con:zscted to)
(~d& ~s~ where work,,~ 1il be pe~o~ec)
TSe nature of ~s work conshts of: (Check One or Deschbe the Nature of Work)
~ Reoomection or new circuit for r~lacement EI,c~c 'Water H~at,r or power vented
wat~: heat~.
~ Recomecfion of thc S~wice ~n~ce Cable, Meter Box, akeratiom to receptacle,
~d li~dng fix~e~ due to siding / serif h~talIat~on. Not~: New S~ice
Entr~ce Cables will require a ~ep~at~ petal:.
~ Recom~etlon or new cimui't for the replac~e~: ofo~hcr pem~nendy wired
app!i~.ce~ / fixtures.
New ckcuit.for ~h, ~dEtion of~'C tc ~ indhddual dwelling unit ~ousc or the
indMdual ~y~mm~ m a duplex or condominh~m), including ~equired ~ervice
elec~ficaI outiet~,
The vMue of th~s work is S ~,$
I hereby v~fy thh work. will be performed by mn employee cf this compauy and t~,~er ver~£y
the r~cov~cction / installa~ion will be done ~n compliance with mmuuf~.ct~r~r ~d E!ec~c cod~
requireme~B.
Name of Office'.')