HomeMy WebLinkAbout0099114-HVAC (furnace)OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
Chimney Type
Heat Loss
BTU Rate
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
331 W 15TH AVE
GARTMAN MECHANICAL SERVICES
L~J Gas I
[] New
Forced Air
Electric
~_~ Chimney A
~.~ As Approved
~.~ As Per Plan
Owner DAWN M KIRCHOFF
Category 500 - Residential-Heating & Ventilating
L~ Oil I U Electric I M Solar
[] Replace
L} Radiant J L-J Steam I LI NC
[~ Hot Water I ~ Suppl. I ~--Con. Burner
Chimney B ~ Direct Vent O Not Applicable
O Not Applicable J
~I Other
Existing
Variable
Value
Value
No
Create Date
Plan
[] Other
99114
12/17/2002
Solid
LJ vent J
Use/Nature
of Work
SFR/Replace furnace. *EIV form from Beez Electric.
Fees: Valuation $1,885.00 Plan Approval $0.00 Permit Fee Paid
ISsued By: '
[] Permit Voided J
$33.50
Date 12/17/2002
In the performance of this work, I agree to perform all work pursuant to rules goveming the described construction.
Signature Date
Agent/Owner
Address 520 W SO PARK AVE PO BOX 2264 OSHKOSH WI 64903 - 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 must be provided.
Incomplete applications will not be processed.
O../1--IKO/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
Il' you are a contractor participating in the Permit fee Account System and have adeq.u..ate_funds, check here
i.f_~Eott want this processed through_.vour account"~-!
CItECK [] ALL APPLICABLE
RsE CATEGORY
ingle Family FlDuplex
IDMulti-Family FIRental
IElCommercial
Filndustrial
FUEL I~tGas ElElectric [21Solid SYSTEM
r3o
il I-ISolar
121New
FIOther
l~Replace
TYPE
Forced Air I-IRadiant IDSteam r-IA/C IDVent [3Electric
IS CHIMNEY BEING LINED FINo [3Yes ~ LINER SIZE
Note: Ali chimneys shall be sized per the BTU's being vented.
I--IHot Water FISuppl.
& MANUFACTURER
FlCon. Burner
CHIMNEY TYPE FIChimey A [3Chimney B FIDirect Vent IEIOther
HEAT LOSS FIAs Approved FIExisting FINot Applicable
BTU RATE I-lAs Per Plan FIVariable I-IOther Value
vAL6E (inC~lha'i~iat~or aha all materials inciuaing light fixtures) $ / ~ ~75,c7~
~ For applicable projects, an Ele ' ll tt Verification form, signed by the ]Electrical Contractor, must be
attached. If not attached or not applicable, a separate ]Electrical Permit is required.
9/02
. 'i2/1272802 00:42 92023i7255 BEEZ ELECTRIC PAGE 01
2].5 ~h
PO~x 1130
Fax
Electric Installation Verification
(We)
~,,ecz Elcctrk, Inc.
52I W. 12th Oshk~ih_
54902
have been contracted to perform electric installation work for _Gartman. M.echanieal,
at the following address: 331 W. 15th ..
The nature of the work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles and
lighting ~tures due to siding / soffit installation. Note: New Service Entrance Cables
will require a separate permit.
Reconnection or new circuit for other permanently wired appliances / fixtures.
Other
The value of this work is $150.00
I hereby verify this work will be performed by an employee of this company and further verify the
reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
G~ !2/12/02
(Signature of Company Officer)