HomeMy WebLinkAbout0098460-HVAC (boiler)OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
Chimney Type
Heat LOss
BTU Rate
Use/Nature
of Work
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
No
98460
629 CEAPE AVE
TENTH STREET STATION INC
Gas
[] New
[_~ Forced Air
[] Electric
b-J Radiant
[] Hot Water
Chimney A (..~Chimney B
~ As Approved O Existing
J~ As Per Plan (.~ Variable
Owner LEE J TRITT
Category 500- Residential-Heating & Ventilating
U Electric j [~ Solar J E~-~olid
[] Replace J [] Other
LJ Steam J ~d NC J ~ Vent
[] Suppl. I E~Con. Burner 1
O Direct Vent ~ Not Applicable J
~ Not Applicable j Value 0
~I Other J Value 105m btu
Create Date 11/06/2002
Plan
3UPLEX/Replace boiler. *EIV form from Drexler Electric.
Fees: Valuation
Issued By:
$3,000.00 Plan Approval
$0.00 Permit Fee Paid
[] Permit Voided J
$50.00
Date 11/06/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
AgentJOwner
Address 924 OHIO STREET OSHKOSH WI 54902 -0 Telephone Number
236-8770
11/05/2002 22:09 9202360150 TENTHSTREETSTATION PAGE 01
City Of Oshkosh
Division of Inspection Servi~s
P.O. Box 1130
Oshkosh, WI 54902-1130
Phone (920) 2~f050
~ (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories musl be provided.
Incomplete applications will not be processed.
· Applicalion(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being
normal permit fee, which ever is greater.
OR
lf .¥'ou a,'e..d~ co.ntractor participating in the permit fee ,4ccount System and h~ve
ifyoU want this processed through ?our account
DATE [ t~./~'?'
CHECK E ALL APPLICABLE
USE CATEGORY
r'ISingle Family [~)uplex
OMulti-Family CIRental
CICommemial [
FUEL IlfiOas ElElectric l~Solid SYSTEM
I--JOil Elgolar
nNew
~Other
TYPE
r'lForced Air CIRadiant ElSteam r'lA/C nVcnt ,F1Electne
IS CHIMNEY BEING LII~D l-INo II'Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being venied.
13~Iot Water EJSuppl.
& MANL~ACTLrRER_~/~"x t- ~
CHIMNEY TYPE rlChirtmey A ElChimney B
It2EAT LOSS ~As Approved ~lExisting
BTU RATE r'lAs Per Plan [3Variable
l~Dir¢ct Vent ElOther
~Not Applicable
~Other Value
cc)
VAI. UE (Including labor and all materials Including light fixtures) $ ~3000
ELEcrRICAL CONTRACTOR ~ ~.~(-(,.~-'lq-- ....
For applicable projects, an-Electric Installation Verification form, signed by th,
attacl~ed. If not attached or not applicable, a separate Electrical Permit is required.
........... 11/8512882
22:89
9282368158
TENTHSTREETSTAT I ON
PAGE
O2
Electric Installation Verification
(Electrical Contractor Name)
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work fore~ ~ $:r',~/e 4
(Name of party contracted to)
(Address where work will be performed)
at the following address;
The nature of thc work consists of.- (Check One or Dc.scribe the Nature of Work)
Recormection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Recormection 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.
Recormection or new circuit for the replacement of other permanently wired
appliances / fixtures.
New circuit for the addition of A/C to an individual dwelling untt (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $__/'~,~-~')
I hereby verify this work will be performed by an employee of this company and further verify
the recormection / installation will be done in compliance with manufacturer and Electric code
requirements.
( 'gn C°r~pany Officer) (Prim Name of Officer) (Date)