HomeMy WebLinkAbout0098546-HVAC (furnace)OSHKOSH
ON THE WATER
,Job Address 2034 DOTY ST
Contractor PALISADES SHEET METAL
Fuel L~J Gas I
System [] New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Owner FRED C BEHLENDORF
Category 500- Residential-Heating & Ventilating
No 98546
Create Date 11/11/2002
Plan
[~-~lectric 1 [ [~-~olid
[] Replace [] Other
~ Oil I M Solar
[ I
[~j Forced Air J ~ Radiant J L--] steam I L-J NC
U Electric I L~ Hot Water I ~-Suppl. ] ~ Con. Burner
Chimney Type ~.~ Chimney A ~..~ Chimney B ~.~ Direct Vent O Not Applicable
Heat Loss ~) As Approved O Existing ~J~ Not Applicable I Value
BTU Rate ~ As Per Plan ~..~ Variable ~I Other I Value
Use/Nature SFR/Replace furnace.
of Work
Fees: Valuation $2,600.00 Plan Approval $0.00 Permit Fee Paid $44.00
Issued By: Date 11/11/2002
[] Permit Voided i
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 1475 RACINE ROAD MENASHA WI 54952 -0 Telephone Number (920) 729-1282
Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903-1130
Fax # (920) 236-5084
Phone (920) 236-5048
JOB ADDRESS
OWNER
All fields/information after bold categories must
Zncomplete applications will not be processed.
D&TE 11/7/02
2034 Dory St Oshkosh
Leadsafe Services
CONTRACTOR
Palisades Sheet Metal
CIRCLE ALL APPLICABLE
USE CATEGORY <SINGLE FAMIL__~ DUPLEX
FUEL ~S~ OIL ELECTRIC
TYPE ~D~ RADIANT
ELECTRIC
MULTI - FAMILY
SOLAR
OTHER
STEAM
HOT WATER SUPPL.
LINER SIZE ~ ~
IS CHIM1TEY BEIN~ LINED
~ote: All chimneys shall be sized per the BTU's being yen{ed.
CHIMNEY B
COMMERCIAL
SOLID
CHIMNEY TYPE
CHIMNEY A
A/C VENT
CON. BURNER
DIRECTVENT
INDUSTRIAL
OTHER
HEAT LOSS
AS APPROVED
EXISTING
NOT APPLICABLE
BTU RATE AS PER PLAN VARIABLE
OTHER VALUE
NATURE OF WORK:
VALUE (Includin~ labor and materials) $ 2600.00
ELECTRICAL CONTRACTOR
Electrical installation of new/replacement equipment shall be done by licensed
contractors.
Valuation Fees
$0 to $1,000.00 ....................................................................................... $20.00
$1,000.01 to $10,000.00 ................................. 2 ......................................... $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 ~o pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.