HomeMy WebLinkAbout0098623-HVAC (boiler)OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
500 JOSSLYN ST
GARTMAN MECHANICAL SERVICES
[] Gas
[] New
L~ Forced Air
[] Electric
~ Radiant
[] Hot Water
Chimney Type ~ ChimneyA O Chimney B
Heat Loss O As Approved ~ Existing
BTU Rate ~ As Per Plan O Variable
Owner
CategorY
[] Electric
[] Replace
[~ Steam
[~-~ppl.
JAMES J LANG
500 - Residential-Heating & Ventilating
[] Solar
~1 NC
[] Con. Burner
Direct Vent ~1 Not Applicable I
O Not Applicable I Value
~1 Other I Value
No 98623
Create Date 11/13/2002
Plan
L~ Solid
[] Other
Vent
Use/Nature
of Work
FFR/
Replace hot water heat. *EIV form from Beez Electric.
Fees: Valuation
Issued By:
$4,350.00 Plan Approval
$0.00 Permit Fee Paid
[] Permit VoidedI
$71.00
Date 11/13/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 520 W SO PARK AVE PO BOX 2264 OSHKOSH WI 54903 - 2264 Telephone Number
(920)231-5530
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 mus~ be provided.
Incomplete applications will not be processed.
Of HKO/H
ON THE WATER
· Application(s) and fee(s) can be brought to Cit~ 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
l~__~,ou are a contractor participating in the Permit fee Account Sg~tem and have adequate _funds. check here
i_fD'o:~ want this processed throt~.g~ your account"-[3"J
JOB ADDRESS
CONTRACTOR
CHI'.?~CK [] ALL APPLICABLE
CATEGORY
ngle Family FIDuplex' . ~Multi-Family' . FIRental
FUEI, Xl~Gas l-lElectric [-3Solid
IDOil I-ISolar
TYPE
rlForced Air EIRadiant F1Steam rlA/C FIVent IZIElectric
IS CIIIMNEY BEING LINED [3No FIYes - LINER SIZE
N~ .... All chimneys shall be sized per the BTU's being vented.
'tot Water FISuppl. [EICon. Burner
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS
BTU RATE
[]Chimney A
riAs Approved
FIAs Per Plan
[3Chimney B
[3Existing
rlVariable
[]Direct Vent
[3Not Applicable
rlOther Value
[3Other
DESCRIPTION OF ALL WORK BEING DONE
VAI ,UE (Includin'g labor and all mater'.als including light fixtures) $ ' ~
EI_,E CTRICAL CONTRACTOR ~ ~,,
[] For applicable projects, an Electric In~'iSon Verification form, signed by the Electrical Contractor, must be
attached. If not attached or nc, t applicable, a separate Electrical Perrnit is required.
9/02
11/18/2882 28:15 9282317255 BEEZ' ELECTRIC PAGE 83
Electric Installation Verification
(I) (We) Beez Elec~c. Inc ....
521 W..l,2.th. Ozhkosh WI 54902
have been contracted to perform electric installation work for .Garb. an Mechanical,
at the following address: 500 Jossl'~
The nature oft.he work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacemen~ Heating Plant and/or MC Condenser.
Reconnection or new circuit for replacement Electric Water Heater.
Reco~eaion of the Senhce Entrance Cable, Meter Box, alterations to receptacles and
lighting fixtures due to siding / soffit ir~allafion. Note: New Service Entrance Cables
will require a separate permit.
Recormection or n~w circuit for other permanently wired appliances / fixtures_
Other
The value of this work is $!,50.00
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.
(Signatur~ of Company Officer)
G-arv Bie~g,ey. ,1_1/11/02