HomeMy WebLinkAbout0098900-HVAC (furnace)OSHKOSH
ON THE WATER
Job Address 227 DALE AVE
Contractor ANDRESEN SHEET METAL
Fuel L~J Gas
System [] New
Forced Air
Electric
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
Radiant
Hot Water
Chimney Type ~ Chimney A (.~ Chimney B
Heat Loss ~ As Approved ~1~ Existing
BTU Rate ~) As Per Plan ~ Variable
Owner ROBERT/BARBARA SHIRTZ
Category 500 - Residential-Heating & Ventilating
~ Electric I ~ Solar
[] Replace
Steam J LJ NC
Suppl. I U Con. Burner
(.,..) Not Applicable J
Not Applicable J Value
Other I Value
Direct Vent
No 98900
Create Date 12/04/2002
Plan
[] Solid
[] Other
L-J vent
75m
Use/Nature ;FR/Furnace upgrade. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$2,300.00 Plan Approval
$0.00 Permit Fee Paid
[] Permit Voided J
$39.50
Date 12/04/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 2913 WITZELAVE OSHKOSH WI 54904 -6539 Telephone Number
(920) 233-0323
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
RECEIVED
DEC 0 4 2002
DEPARTMENT OF
H V A I f . N'10 N
All information after bold categories must be provided.
Incomplete applications will not be processed.
Q/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 in the Permit.fee Account System and have adequate funds, check here
({'you want this processed through your account ["]
CHECK [] ALL APPLICABLE
, ? if ;!,. *, ;''; :; ':' }~ ';:,i ~::' ; ' ~-;:!~. ;!":Ci: i(~ !7':'"" ~ :i::, .,. ':
TEGORY
FamilyrElDuplcx · FIMulti-Family F1Rcntal ~ ElCommcr¢ial ...... F!Industrial.
FUEL d~Gas ElElectric ElSolid SYSTEM DNew ~eplace
F1Oil FlSolar
ed Air DRadiant FISteam FIA/C FIVent F1Electric
IS CHIMNEY BEING LINED FlNo4~es - LINER SIZE ,.~
Note: All chimneys shall be sized per the BTU's being vented.
F1Other
F1Hot Water FISuppl. FICon. Burner
& MANUFACTURER ~_~.~qr (~ocYff
CHIMNEY TYPE V1Chimney A V1Chi~mney B -~erect Vent BOther
HEAT LOSS FIAs Approved ~;]-E~sting FINot Applicable
BTU RATE FIAs Per Plan I-IVariable ElOther Value 7ft¢~
DESCRIPTION OF ALL WORK BEING DONE
vAL~ ~i~'clud'i~ labor, and al! materi~"ncluding light~xtures) $ ~_..~d)O .. ¢o
[3 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.
]Electric Installation Verification
(c__.it~) (State) (zlp Code)
work will be p~c~)
Ti~ uatu~e o!the work etmsi~t~ oF: (C'~eck One ot D~Be ~ Na~e of W~)
~~a~ ~ n~ Ckc~t for ~e r~lacem~t
~ ~t for ~e ad~ti~ of~C to ~ i~Juiduat ~etlt~g ~t~ ~ or the
etec~c~ o~e~,
......... O~h~r
Th~ value, oft,"Us work is $,/6o- ~,~
I hereby v~m~y ~ work v4tt be p~-fcn~ed by an ~nplol,'~ of :his company md "tkr-.h~r verify
L~ te~on:~.~.,fio:t / installahon will be done in com,ullau~e wi!h ~anm+'acmre? and Electric ~!e
(Sisnsra~ of Company Office, r) (D~:)
(Trlu+. Nam~ ~f Ofl~;=)