HomeMy WebLinkAbout0098622-HVAC (boiler)OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
820 MILLER LN
TENTH STREET STATION INC
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
No
98622
[] Gas I
[] New
LJ Forced Air I
[] Electric ]
b--J Radiant
[] Hot Water
Chimney Type ~ ChimneyA O Chimney B
Heat Loss ~ As Approved O Existing
BTU Rate O As Per Plan (-.2 Variable
Owner GARY C DEYOUNG
Category 500 - Residential-Heating & Ventilating
[~ Electric ]
[] Replace
L--J Steam 1
L~ Suppl. ]
Create Date 11/13/2002
Plan
II solar I I~ Solid
I [] Other I
[~ A/c j L--J vent
[] Con. Burner 1
Direct Vent ~ Not Applicable I
~ Not Applicable I Value
~I Other I Value
77m btu
Use/Nature SFPJ Replace boiler. *EIV form from Drexler Electric.
of Work
Fees: Valuation
Issued By:
$2,295.00 Plan Approval
$0.00 Permit Fee Paid
[] Permit Voided
$39.50
Date 11/13/2002
In the performance of this work, I agree to perform all work PUrsuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 924 OHIO STREET OSHKOSH WI 54902 -0 Telephone Number
236-8770
11~12/2882 84:58
9282368158
TENTHSTREETSTATION
PAGE 81
Cio/of Oshkoah
Division of Inspection Services
P.O. Box 1130
Os~m~ WI 54903-11~0
Phone (920) 236-5050
F~ (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Servi
Oshkosh WI 54903-1128, Commencing work without permit(s) will result in fees being
normal perrmt fee, which ev~ is greater.
OR
If V'OU are 0 cqntrttCtOr varticit~atine in the Permit fee Account System and have adeq,~
i'f You want this procgssed,throu~ch Four account
CHECK I~ ALL APPLICABLE
USE CATEGORY
I~l~Single Family [3Duplex
I-IMulti-Family l~Rontal ~Commer¢ial
FUEL I~lOas CIElectric CISolid SYSTEM CINew I~
I~lOil I-ISolar r'lOther
TYPE
OForced Air E]Radiant 13Steam nA/C DVent .r'lElectric I~-Iot Water Elguppl.
IS CHIM1VEY BEING LINED [$~1o ~Yes - LINER SIZE.
.Note: All chinmeys sKa. Il be aized per thc BTU's being vented.
& MANUFACTURER ....
CHIMNEY TYPE r'lChinmey A ~Chirnney B I~Direct Vent nOther
~AT LOSS ~As Approved ~xisting ~Not A~licablz
B~ ~TE ~As P~ P]~ ~V~able ~O~ Value ~ (~ ~ ~/~.
Dzsc mo
VALUE (Including labor and all materials including light fixtures) $. ,~ ~" t~
ELECTRICAL CONTRACTOR . .~.d_~_~"~'R.,4. ................
[~For applicable projects, an Elecu'/c Installation Verification form, signed by the Electrict,, . .
attached. If not attached or not applicable, a separate Electrical Permit is required.
,. . 11/.12/2002 8d150 9282360158 TENTHSTREETSTATION PAGE 02
Electric Installation Verification
(we) ,. Le-c. -e
(Electrical Contractor Name)
(Address) (City) (.~tate) (Zip Code)
have been contracted to perform electric installation work for~r~
(Name of party contracted to)
at thc following addra~: ~ ~-~ ~f~t' { {¢~-,, L~'
(Address wher~ work will be performed)
Thc nature of the work consists of: (checic One or D~scribe the Nature of Work)
X Reconn~ction or new circuit for r~lacernem Heating Plato ~td/or A/C Condenser.
~ Reconnect/on or new circuit for replacement Blectfic Water Hcater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Serv/ce
Bntranee Cables will r=quire a separate
~ R¢connection or new circuit for the replacement of other permanently wired
appliances / fixtures.
New circuit for the add/t/on of A/C to an individual a%elltng unit (houae or the
individaal systems i~, a duplex or condom/nium), including requ/red aev.,ice
electrical outlets.
_. Other
Thc value oftMs work is $. ff'O ts- ~
I h~cby verify lh/s work will be performed by an employee of this company and fu~her verify
the reconnection / installation will be done in compliauce with manufacturer and Electric code
(Si~nature ~f Company Officer)
(Print Name of Officer)
(Date)