HomeMy WebLinkAbout0099117-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
1716 HICKORY ST
E C MERRILL INC
Gas
[] New
Owner DENNIS M/ANNE FLYNN
Chimney A
~ As Approved O Existing
~.~ As Per Plan O Variable
Category 500 - Residential-Heating & Ventilating
I U Oil [ L~ Electric I ~ Solar
I [] Replace I
Forced Air I LJ Radiant J ~J Steam I I~ NC I
Electric I ~ Hot Water I [~ Suppl. I ~1 Con. Burner I
~.~ Chimney B ~ Direct Vent ~ Not Applicable I
~ Not Applicable I Value
~ Other I Value
No 99117
Create Date 12/17/2002
Plan
M Solid
[] Other
Vent
Use/Nature SFPJ Replace furnace. *EIV form from Witzke Electric.
of Work
Fees: Valuation $3,435.00 Plan Approval $0.00 Permit Fee Paid
Issued By:
[] Permit Voided J
$57.50
Date 12/17/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 804 WITZEL AVE OSHKOSH WI 54902 - 5710 Telephone Number
(920) 235-3600
P.O. Box 1130
Os~hkosh, 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.
OSHKOSH
ON ?HE WA'r~R
Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to InSPectibn ServiCe.s, POB6x 1128~
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plutsthe
normal permit fee, which ever is greater.
I£¥ou are a contractor participating in the Permit fee Account System and have adequate _funds, check 5here
if you want this processed through your account ~
CHECK [] ALL APPLICABLE
USE CATEGORY
~ngle Family I"lDuplex
[2Multi-Family
D£PAi TM£NT OF
COMM! Ty DEVELOPMENT
[2Rental [2Commercial [2Industr/al
FUEL l~as [3Electric F1Solid SYSTEM [3New
I-IOil [3Solar [2Other
e~Replace
TYPE
2~3q:rorced Air F1Radiant [3Steam [3A/C F1Vent F1Electric Elliot Water [3Suppl. F1Con. Burner
IS CHIMNEY BEING LINED FINo V1Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CmMNEY TYPE
ItEAT LOSS
BTU RATE
[3Chirrmey A
[3As Approved
[3As Per Plan
[3Chimney B
j~Exist~g
j~Variable
ll~irect Vent
FlNot Applicable
[3Other Value
[3Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials including light fixtures)
ELECTRICAL CONTRACTOR
OR ~Electric Installation Verification form attached(If Replacement).
Electrical installation of new/replacement equtpment shall be done by licensed covavactors.
1: ~.6Ph'l HiTZKE ELECTRIC
Electric Installatfon Verification
(Electrical Contract:or Name) ~--
fJ ,
.15_5 E.
(Address) (C]ty.} ........
,Sta~) (Zip Cod~)
hav~ been conic;ed :c per~o~ eiecdc m~tallatfon work for ~~
Th~ n~r~r~ of~ work ¢on~fs~ of: (Check One or Describe ~¢ N'~e of Work)
~ ~eco~ectfon or n~ circuit for replacement Heat~g Pl~t m~or ~C Condenser.
~ Reelection or new circuit ~br mp!acemcn, Elec~c Water ~est~ er power vet~ed
wator heater,
".' :~'-:'~' an~ li~2i5~ fix~e~ due to ~idin~ / ¢o~t inst¢ti~tion, Note: New
Ent~e Cable~ will reqdm ~ ~a~e
~ Racom~c~ion or new ¢~cuit for ~e replacement of other pem¢~en:ty wired
appli~ees / fixtures.
~ New circuit,for ~e addition of~C m m individ~M dw~iling ~it (hm~se or
individu~ systems ~ ~ duplex or condo~nium), ine:u.dmg requJre~ sc~/cc
~ O~e
Thc value of d'4$ work is $~,
I hereby verify this work will be performed by ~n employee of this comp~.uy e.a'-,d fur. her verify
the reconneedon / installation will be done in ccmpli~ce with m~uhcrarer ~d ElecTric code
requirements.
(PrJn; ~-
. ;mine of Officer)