HomeMy WebLinkAbout0099456 H(~ CITY OF OSHKOSH
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 635 OLSON AVE Owner GARY L/CINDY L FURTICK
Contractor RASMUSSEN'S HEATING & A/C INC Category 502 - Residential-Both
Fuel ~J Gas J ~J Oil b~ Electric ~J Solar
System ~J New ~ ~J Replace ~ ~J Other
~J Forced Air I ~J Radiant L~ Steam ~J A/C
~J Electric I ~J Hot Water b~ suppl. ~J Con. Burner
Chimney Type I~ Chimney A O Chimney B ~ Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 60m btu
No
Create Date
Plan
~J Solid
Vent
99456
01/14/2003
Use/Nature SFR/Replace furnace & A/C. *EIV form from Slim's Electric.
of Work
Fees: Valuation
Issued By:
$6,342.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$101.00
Date 01/14/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number
920-235-6569
City of Oshkosh
Dix4sion of Inspeclion Servic~.s
P.O. Box 1130
Oshkosh, WI $4903-1130
Phone (920) 236-5050 ~
Fax (920) 236-5084
Offt- O,ffH
THE WATER
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, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the permit, fee A,ccount SF~tem and have adequate funds, check here
~f_you want this processed,through yoUr account,, ['~ - '
JOBADDm SS
CONTRACTOR.. ~e,.$ ~..u ~.~.~ ~'. ~
4VA,c,
CI~CK [] ALL APPLICABLE
USE CATEGORY
~Single Family E]Duplcx
r'IMulti-Family
E]Rcntal
ElCommercial
UlIndustrial
FUEL [glGas EIElectric E]Solid SYSTEM E1New
EIOil DSolar I-IOthcr
TYPE
~Forced Air DRadiant r'lSteam []~A/C I-IVent UIElectric OHot Water
IS C~Y BEING I.INE1) [glNo OYes - LINER Sim
Note: All chimneys shall be sized per the BTU's being vented.
,l~Replace
CHIMNEY TYPE
HKAT LOSS
BTU RATE
ElChinmey A
nas Approved
r'iAs per Plan
~inmey B
ElVar ble
r'lsupPl. F'lCon. Burner
& MANUFACTURER
EIDirect Vent ~Other
EINot Applicable
VALUE (I~duding labor and all materials including light fixtures). $
ELECTRICAL CONTRACTOR ~ ~ \v,~'~ ~le-c+ r ~ c__
,~1 For applicable projects, an Electric ~._,~allation Vetification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical i~ermit i~ required,~''.
Electric installation Verification
I (We)
(Electrical Contractor Name)
(A~ress) (Cit~)
~J ~ ~q q~tl
(State) (Zip Code)
have bccn contmoted to perform electric installati~ work for
tho fonowing a, tar,~: ~,[g ~ 0 [ g ~0
(Address where work will be performed)
The nature of the work consists off ( .Ch~k One or Descn~oo the Nature of Work)
_ .: Reoonneotion of the Sorvi.oe Bntranoe Cable, Meter Box, alierations to receptacles.
and lighting fixtm~ due to siding / soffit installation. Note: New Service
~ce Cables will ~ a ~~t
appliances / ~
........ New circuit fur ~ addition ofA/C ~o an ~ dmZ/ag u~ (house or the
The value of this work is $ ....... .,.~90. O0
I hereby v~.fy ~s wmkwffi bc pcrfommd by an eml~ye~ ofthls ~and fm'ther v~
tho rec, omm~on / imlallalion will be done in comp~ wilh msmffac~rer and Elcctdc code
,, /- 7-~3