HomeMy WebLinkAbout0098719-HVAC (furnace & a/c) CITY OF OSHKOSH
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address '1428 JEFFERSON ST Owner BARBARA A SWANKE
Contractor RASMUSSEN'S HEATING & NC INC Category 502 - Residential-Both
Fuel ~j Gas I [] Oil ] [] Electric 1 E~-Solar
System [] New J [] Replace
~j Forced Air I LJ Radiant J L-J Steam J L~J NC
[] Electric 1 [] Hot Water ] [] Suppl. 1 [] Con. Burner
Chimney Type ~.~ Chimney A ~t Chimney B O Direct Vent (_~ Not Applicable
Heat Loss ~ As Approved O Existing ~ Not Applicable I Value
BTU Rate ~ As Per Plan ~ Variable ~1 Other I Value 80m
No 98719
Create Date 11/19/2002
Plan
~J Solid
[] Other
L-.J vent
Use/Nature SFR/Install furnace & NC. *EIV form from Slim's Electric.
of Work
Fees: Valuation
Issued By:
$8,572.00 Plan Approval $0.00 Permit Fee Paid
[] Permit Voided
$134.00
Date 11/19/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number
920-235-6569
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
OJ'HKOj'H
ON THE '&ATER
Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, 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
If you are a contractor participating tn the Permit_fee Account System and have adequate funds, check here
if you want this processed through your account
DATE
CONTRACTOR
CHECK [] ALL APPLICABLE
USE CATEGORY
~Single Family I-IDuplex
FIMulti-Family
F1Rental F1Commercial Ullndustrial
FUEL ~Oas F1Electric FISolid SYSTEM F1New ~Replace
FIOil FISolar FIOther
TYPE.
~Forced Air I=IRadiant [3Steam ~A/C F1Vent r'tElectdc
IS C~Y BEING LINED l~No E3Yes - LINER SIZE
Note: All chinmeys shall be sized per the BTU's being vented.
CmMNEY TYPE [3Chimney A ~Chinmey B
HE. AT LOSS I-lAs Approved ~.xisting
BTU RATE FIAs Per Plan FIVariable
~Hot Water FISuppl.
& MANUFACTURER
[3Direct Vent [3Other
F1Not Applicable
~SI,Other Value /~O~ ~C~D
DESCRIPTION OF ALL WORK BEING DONE
r-ICon. Burner
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR '~[
fi~l,~or applicable projects, an Eleotric Installation Verification form, signed by. the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is requited.
Electric Installation Verification
(Bleotrical Contmotor Name)
have been conllacr~ io perform olectrio ~ work for,
at th~ following add2~:
(Address where woflc will be performed)
Cap co~)
The nature ofthe work consi~ oi (.Ch~ One or Describe the Nature of Work)
~ or new chcuit fi)r rephcement Heating Plant and/or ArC Condenser.
Reconnection or new circuit for r~hoemeat llkotfic Water Heater or power vented
~ of tho St~'i~. lt~ntra~ce Cable, Meier Box, altm~ons to receptacles.
and lighting fixtures due to siding/soffit installation. Note: New Service
Reooma~on or new ckonit for the replaoan~ of Other pennan~¥ wired
applian~ / flxtm~.
Hew cim~ fro' the addition of A/C to an tnMvid~dw~tlingtmit (house orthe
The value ofthis work is $ ,,
I h~eby vcrlfy*hls work will bo ~ed by fin employee of~ company mad further verify
the rcconneofion / !nsiahlion will be done in c0mp]imlce with ~ and Elechic code
· .
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