HomeMy WebLinkAbout0098456 H (~ CITY OF OSHKOSH No 98456
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 118 W MELVIN AVE Owner DONALD R LOFGREN
Contractor TENTH STREET STATION INC Category 502 - Residential-Both
Fuel [~j Gas I U Oil I LJ Electric I U Solar
System [] New I [] Replace I [] Other
¢b~J Forced Air I [~ Radiant J bd Steam I Ld A/C J b-J vent
L~ Electric I ~ Hot Water I U Suppl. I U Con. Burner
Chimney Type ~ Chimney A (~ Chimney B I~ Direct Vent ~ Not Applicable
Heat Loss ~.~ As Approved ~t Existing ~ Not Applicable I Value 0
BTU Rate ~ As Per Plan ~ Variable ~I Other I Value SOn heat & 2.5 ton a/c
Create Date 11/06/2002
Plan
Use/Nature
of Work
FFR/
Replace furnace & add new a/c. *EIV form from Drexler Electric.
Fees: Valuation $4,443.71 Plan Approval $0.00 Permit Fee Paid $72.50
Issued By: Date 11/06/2002
[] Permit Voided J
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 924 OHIO STREET OSHKOSH WI 54902 -0 Telephone Number 236-8770
City of Oshkosh
Division of Inipcction Services
P.O. Box I 130
Oshkosh, Wl 54903-1
Phone (920) 236-$050
Fax (9:~0) 236-508,1
HVAC PERMIT APPLICATION
All information after bold ca~gori~s must be provided.
Incomplet~ aPPlications will not bc processed.
· Application(s) a.nd fee(s) can be brought to City Hall, Room 205 or mailed to l~spcction Services,
Oshkosh wi $4903-1128. Commencing work without permit(s) will result in fe~ being doubled
normal permit fee, which ever is greater.
OR
l_f ~ou are a cOntraCtOr, l~artic~Da~in_~ in fie permir fce ~Ccount System and have ~dcquate
~f you wa~t thtx _or_o_c_ex~ed, f~ou~h ~our account ~
CHECK [] ALL APPLICABLE
USE CATEGORY
'[~lSingl¢ Family ElDuplcx
ElMulti-Family EIRcntal
ElCommercial Elln('::
FI/EL IgtGas EIEIe~o ElSolid
EIOil r'lSolar
~E
~cedAir ~Radi~t ~St~m ~C DV~
IS C~Y BEING L~ED ~No ~Y~ - L~R S~E.
. No~: ~ ch~C~ s~ll ~ ~ed ~ ~ B~'s ~ing vented.
I~ew ~t'C
mOther
ElHotWatl:r ElSuppl. ElCo:
CHIMNEY TYPE ElChiraney A ElChimney B ~Dire¢t V~nt
HEAT LOSS r'lAs Approwd [l~xiating ~Not Applicable
BTU RATE EIAs Per Plan [3Variable I'lOther Value., 8b. ooo..
DESCRIPTION Or ALL WORK BEING DONE,. ff~ ,/~n~.c.
VALUE (Including labor and ali materials iocludln~ ligl~t fixtures) $ I~,/L,/~.. '/I ~C'~_e..: ~ 6D
ELECTI~CAL CONTRA~OR ~ f~. .. ~ ~
]{~For nppli¢~ble Igojects, nn Elec~¢ Instnllation Vcrificatiot~ form, signed by the Eleetrica] Co=t,.
attached. If not attached or not applicable, a separate Elecwical P~nit is required.
FO Ro~ Jl3O
O~koG ~ 54~0~- ] 130
Electric Installation Verification
(Eectrical Contractor Name)
(Addr ) (City) (Sta ) (Zip Code)
~e ofp~ con~t~ to)
(Ad~s where wo~ ~11 be ~M)
of~ work mmi~s of: (~k ~e or Des~ ~o N~c of W~)
~o~fion ~ n~ c~t for ~lac~l H~g P!~t ~or ~C Cinder.
R~~on or ~ ci~t for ~la~t El~c Water H~ or p~ v~tcd
water ~.
~~on of~ S~ B~ ~le, Me~ Box, ~tcrali~ to ~1~
~d ~t~ ~ duc W sidi~ / soffi~ i~a~on. Note: N~ S~ce
~~ C~lm ~I1 req~e a $~ate
~o~Uon or n~ c~cuit for ~c r~lac~t ofo~ ~~y ~
~p~c~ / fix~es.
New c~ ~r ~e a~o~ of ~C to ~ ~i~dual d~ell~g ~t ~o~e or ~e
~c~
O&~
Thc value of this work is $_/,ff~* ~"
I' he~%¥ vcri~ this work will be p,rfotm~ by ~n employee of this ,ompany Md further verify,
the r,cormeetion ! i~tallation will be done ia mmpliance with manufacturer and BIce~c code
requh'em~ts.
(Signatur~ of Company Officer)
(Print Name of Officer) (Dkte)