HomeMy WebLinkAbout0098884 HOSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
1349 WINNEBAGO AVE
TENTH STREET STATION INC
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
No
98884
Gas
[] New
Forced Air
Electric
Oil
Radiant
Hot Water
Chimney Type ~.~ Chimney A ~ Chimney B
Heat Loss ~_~ As Approved O Existing
BTU Rate ~ As Per Plan ~ Variable
Owner KEVIN/LISA REVOLINSKI
Category 502- Residential-Both
~ Electric I U Solar
[] Replace I
~_~ Steam J L~J NC
~J SupPl. i Con. Burner
Create Date 12/03/2002
Plan
~] Solid
[] Other
L-~ vent
Direct Vent ~ Not Applicable i
~ Not Applicable I Value
~ Other I Value
0
75m btu heat & 2.5t NC
Use/Nature SFR/Replace furnace, NC & line chimney. *EIV form from Drexler Electric.
of Work
Fees: Valuation $4,055.00 Plan Approval $0.00
Issued By:
Permit Fee Paid
[] Permit Voided
$66.50
Date 12/03/2002
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 924 OHIO STREET OSHKOSH WI 54902 -0 Telephone Number
236-8770
1~/02/2002 21:06 9202360150 TENTHSTREETSTATION PAGE 01
City of Oshkosh
Division of lnspecfiot~ .qen'ice.~
P.O. Box 1 I30
Oshkosh, WI 5a903.-1130
Phone (920) 236-505¢)
Fax (920) 236,508.:
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services.
Oshkosh WI 5a903-1128. Commencing work without permit(s) will result in fees being doubled
vormal permit fee, which ever is greater.
OR
If ycu area contractor par. ttci~ating..tn the Permit.fee Account Svf~em and have adc#unto
if yOU,__w, ont thi.~ ~!'_Oc~.'.ssed through },our qqcount [Y~
onxE
CHECK lEI ALI., APPLICABLE
USE CATEGORY
I~inglg Family ElDuplex
[2]Multi-Family 121RemalE]Commercial
FUEL li~l'O as IZIElectrjc ~Solid SYSTEM
~lOil nSolar
TYPE
I~ifForced Air ORadiant OSteam [iiYA/C nVenx I-IElectric
IS CHIMNEY BEING LINED E3No l~'Yes - I.,INER SIZE ~ ~'
Note: All cbirnney~ .~ha;I be sized per thc BTU's being vetoed.
CHIMNEY TYPE UtChimney A EIChimney B
IttEAT LOSS iL]As Approved I~:Exist:ng
BTU RATE ~As P~ Plan ~Variablc
DNew ~epl~ ·
FIOthet
FlHot Water ElSuppl.
& M ANUFAC'I'UR ER./~ff~i
]~Direct Vent [3Other
~Not Applicable
OOther Value 7fmo 8~4//~/4e'a~t
DESCI~IPTION ~OF &LL WORK BEING DONE.
VALUE (Including labor and all materials including light
ELECTRICAL CONTRACTOR ~) F-~._~?,f,,c.
~For applicable m'oject$, an Electric lnslallation Verification form, signed by the Elec!
attached If no~ attached or nm applicable, a separate Electrical Permit is required.
rical C.
12/02/2002
21: 06 9282368150
TENTHSTREETSTAT][ ON
PAGE 02
ElectFJc Installation Verification
~l~cmc,! Contmcto~ Nan.)
ha~e b~n contt~ct~ to perfonu c}~tt~c ~l~latial work
~me ofp~y
~c mmt~ ofUle wo~ ~ia~ of: (~k ~e or ~c~be thc Nature of Wot
~ Re~tio~ o~ n~ oi~it for ~~
.... R~m~tion m n~ c~t~t ~r repla~ont El~rk Wo~F [~oate
and lighting fixtm'~ due ~ mMifl81 ~t h~tellmion.
~ Cables ~ll r~uil~ a ~ ~it.
~li~o~s / fi~mr~,
indlvidu~ i~tem i~ a d~plex
eJ~t~o~ ouO~,
~ha.
I hereby v~fy'fl~is work wiJl be performed by ~ elJTployee of trill company in(
the recoltueotion / installation will be doge iff complimce with manufacturer and
T~ 'd
(Print lVam~ of Officer) -- -