HomeMy WebLinkAbout0098729-HVAC (furnace)OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
121 E MELVIN AVE
A-1 HEATING & NC INC
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
Owner TONI M EDWARDS
Category 500 - Residential-Heating & Ventilating
[] Gas [ [] Oil
[] New J
j~J Forced Air I L~ Radiant
[] Electric I ~-Hot Water
Chimney Type
Heat Loss
BTU Rate
Use/Nature IFR/
of Work
Chimney A (.~ Chimney B
~ As Approved ~ Existing
~ As Per Plan ~ Variable
[] Electric
[] Replace
E~--~olar
LJ Steam J~ NC
[] Suppl. L~ Con. Burner
Direct Vent ~1t Not Applicable
~ Not Applicable J Value
O Other i Value
· No 98729
Create Date 11/14/2002
Plan
~ Solid
[] Other
~j Vent j
0
65M
Replace furnace. *EIV form from Homeowner.
Fees: Valuation
Issued By:
$3,500.00 Plan Approval
$0.00 Permit Fee Paid
$57.50
Date 11/20/2002
[] Permit Voided ]
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address W8078 HILLCREST COURT HORTONVILLE WI 54944 -0 Telephone Number
(920)779-8838
A1. I fields/information a~e~::boI~ ~'ncomplete applicat ionn
Note~ All chi~eys shall be sized
VAL~
R6CEIVffD
NOV 1 8 200/
COMMERCIAL INDUSTRIAL
SOLID
vm~T
DIRECT VENT
NOT APPLI~
$o ~o $1,ooo.oo ...................................... ~ ...... ~ ................. 8~o.o0
$1,000.00 D~US: ~.$1.S0 :~ 8100.00 valuation or ~rt t~reo~
~[0,0o0.o~ co $2s,oo0.oo .................. ~~ ¥: .................................... $I58.o0 ~or
$I0,000.00 pl~'~$1,.00 ~8'~0.0.00 val~Cton o~ parc thereof
~er $25,0oo 0 ............................ ~~ ............ $3o5.00 plus
peg~ $100.00 val~i~ or par~ ~hereo~
· ~hmi~ pa~en~ wi~h application. ~. F~!u~::~O pay within 30 ~ye will =eeul~
~ees bein9 do. led or $100.00 plea ~e n~l pe~iC ~ee, w~ e~r is
Electric Installation Verification
l(We) .....
(print homeowner(s) name)
the homeowner(s) of
(address where work is to bc pcrformed)
accept thc responsibility for performing the electrical work ns stated below for the property listed
aSovc.
The nature of the work consists of.' (Check One or Describe thc Nature of Work)
. / Recormection or new circuit for replacement Heating Plant and/or A/C Condenser.
........ Recormection or new circuit for replacement Blectric Water Heater or power vented
water heater.
Recormcction of thc Service Entraace Cable, Meter Box, alterations to receptacles
and lishtin$ fixtures due to siding / soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reconnection or new circuit for thc r~lacement of other permanontly wired
appliances / fixtures.
New circuit for the addition of A/C to an indivMaai dwelling unit, including
required service electrical outlets. Note: Homeowner~ ca** only do their own
electric on a single family owner occupied home. Work on a condominium,
duplex, rental, or multi.use building wouM require a licensed master
electrician.
The value of this work is $ ~'z/y. ~ t~ ....
I hereby verify this work will bo performed by me and further redly the reconnection /
installation will be done in compliance with manufacturer and Electric code requirements.,
Homeowner(s) Signature
(Date)
N~£0:60 TOOE £T .oaa : '[~q ×U3 : L,E~3