HomeMy WebLinkAbout0098581-HVAC (boiler)OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
1705 WHITE SWAN DR
RASMUSSEN'S HEATING & NC INC
L~ Gas I ~J Oil I
[] New I
J~ Forced Air j J_~ Radiant I
J~ Electric J J~ Hot Water J
Chimney Type ~ Chimney A ~1 Chimney B
Heat Loss ~ As Approved O Existing
BTU Rate ~ As Per Plan (..~ Variable
Owner MARK A H SWIECNRUSSELL L FIC
Category 500 - Residential-Heating & Ventilating
~ Electric J
[] Replace
~J Solar
LJ Steam I [__J NC
L~- suppl. J j~ Con. Burner
Direct Vent (.~ Not Applicable J
(...) Not Applicable J
iJ Other I
Value
Value
No
Create Date
Plan
[] Other
80m
98581
11/12/2002
J~-Solid q
~j Vent J
Use/Nature SFR/Replace boiler. *EIV form from Slim's Electric.
of Work
Fees: Valuation
Issued By:
$5,922.00 Plan Approval
$0.00 Permit Fee Paid
[] Permit Voided J
$95.00
Date 11/12/2002
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
C~y of Oshko~
Division of Inspection Services
P.O. Box 11~0
O~hkosh, WI 54~1130
P~ne (920) 23~5050
F~ (920) ~50~
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
OJ'HKO_/H
ON THE WATER
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 ~4ccou.n.t System and ha.ye, adequate funds, check here,
if you want this procqssed through ~our account·.["]
DATE
CONTRACTOR
CHECK [] ALL APPLICABLE
USE CATEGORY
Ii,Single Family FIDuplcx
F1Multi-Family
FIRental [~Commercial Fllndustrial
FUEL ~Gas f'lElectric FISolid SYSTEM F1New
F1Oil FISolar FlOther
FIReplace
TYPE
F1Forced Air FIRadiant F1Steam I"IA/C EVent FIElectric ~Hot Water FISuppI.
IS CHIMNEY BEING LINED lii~No F1Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
a MAm AC
CHIMNEY TYPE ElChimney A I~Chimney B VIDirect Vent EJOtber
1TEAT LOSS ["lAs Approved I~lExisting r'lNot Applicable
BTU RATE I-lAs Per Plan ElVariable l~Other Value 9 ~ ff~
[:ICon. Burner
DESCRIPTION OF ALL WORK BEING DONE ~ r_t~lace~ he ~ J er,
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR ~'s
)~.For applicable projects, an Eleotric ~,~zllation Verification form, signed by thc Electrical Contractor, must be
attached, ffnot attached or not applicable, a separate Electrical Permit is req~
Electric Installation Verification'
I (VCc)_
~fi,m,,,'~ £1~c ....
(Blm~ricad C~r lq~m~)
have b~n contmotod to perform electric inaallation work ~r
The natu~ o£the work consists o~. ( .(~c~k One or Des~n'be the Nature of Work)
" andlfghtingffxtmesduetosidin~/sel~inmHn~on. Note:. NewService
Hnlmnee Cables witl requh'e a selmmte permit.
Reemlnem~m or ne~ eitm~ ~For ~ xmp~ o£ Other pmmanmlfly' wired
New einn~ for lhe addition of A/~ to m ~~~t (lmuse or the
"Jnm~ __,b-,~'systeowtn a dnpl~ ~ mmdomininm), in~ludinS,required senqce
e~ omle~
~ ,'
' the ze~onneefi0~ / inslMhfion will be done m ~ with ~ and Blect~ c°de