HomeMy WebLinkAbout0099232 H(~ ~' CITY OF OSHKOSH No 99232
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 117 W 24TH AVE Owner BEVERLY A SCHNEIDER
Contractor OWNER Category 500 - Residential-Heating & Ventilating
Fuel b~J Gas I ~J Oil I ~ Electric I [] Solar I [~-~olid
System [] New J [] Replace I [] Other
[_~ Forced Air J ~ Radiant I ~ Steam ~ ~ NC I ~ Vent
~ Elec~ic ~ ~ Hot Water ~ ~ Suppl. I ~ Oo.. ~.mer I
Chimney Type ~ Chimney A ~ Chimney B ~ Direct Vent ~ Not Appli~ble ~
Heat L~s ~ As Approved ~ Existing ~ Not Appli~ble ] Value 0
BTU Rate ~ As Per Plan ~ Variable ~ Other ~ Value 175m input ............
Use/Nature SF~ Replace boiler. *Tom Otto Heating & Cooling is doing the work. of Work
Create Date 12/30/2002
Plan
Fees: Valuation $5,000.00 Plan Approval $0.00 Permit Fee Paid $80.00
,[,/I/~ Date 12/30/2002
Issued By:
[] Permit Voided
In the performance of this .work, I agree to p.~orm all work pursuant to rules governing the described construction.
Signature ~_~y.~_..¢.~.~ ~~
~ / / AgentJOwner
Date
Address 117 W 24TH AVE OSHKOSH WI 54902 - 7211 Telephone Number
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
u (¢ Q-TF K-O-JH
ON THE WATER
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
· Appiication(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 in the Permit fee Account System and have adequate funds, check here
if Fou want this processed through Four account ~]
DATE i'd... 30- {a '7,_ '
USE CATEGORY
~Single Family F'IDuplex
F1Multi-Family
F1Rental
F1Commercial Fllndustrial
FUEL Was F1Electric []Solid SYSTEM FINew li~Replace
[]Oil F1Solar FIOther
TYPE
[3Forced Air r"lRadiant •Steam FIA/C •Vent FIElectric [lflI-Iot Water UISuppl. []Con. Burner
IS CHIMNEY BEING LINED [~No FIYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE FIChimney A [itChimney B 71Direct Vent []Other
HEAT LOSS r-lAs Approved EIExisting 71Not Applicable
BTU RATE FIAs Per Plan []Variable []Other Value I "z ~.. e~
F
DESCRIPTION OF ALL WORK BEING DONE -~.k
VALUE (Including labor and all materials including light fixtures) $ ~" ca o o. o O
ELECTRICAL CONTRACTOR
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02