HomeMy WebLinkAbout0099664 HOSHKOSH
ON THE WATER
.lob Address 1620 MARICOPA DR
Contractor RASMUSSEN'S HEATING & A/C INC
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner THOMAS F/JOAN HOREJS
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA O Chimney B
Heat Loss I~ As Approved O Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
99664
02/03/2003
Other
Vent J
100m
Use/Nature SFR/Replace furnace. *EIV form from Slim's Electric.
of Work
Fees: Valuation
Issued By:
$2,870.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$48.50
Date 02/03/2003
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
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI'54903-1130
Phone (920) 2365050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
Of HKOfr-t
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
!f VOU are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account ~ ...
DATE
CHE~CK [] ALL APPLICABLE
USE CATEGORY
[NSingl¢ Family F1Duplex
rlMulti-Family
FIRental []Commercial FlIndustrial
FUEL ~Gas E/Electric E]Solid SYSTEM EINew j~]Replace
E/Oil E/Solar E/Other
TYPE
~2lForced Air E/Radiant F1Steam El,adC E/Vent E/Electric I'-IHot Water E/Suppl. I-ICon. Burner
IS CmMI~Y BEING LINEDJ~Xlo E/Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
~Y TYPE EIChhnney A lYlChirrmey B
H'I~'.AT LOSS E/As Approved l!]Existing
BTU RATE EIAs Per Plan E/Variable
DESCRIPTION OF ALL WORK BEING DONE
& MANUFACTURER
E/Direet V~t E/Other
[]Not Applicable
I~Other Value /049, ~.o
VALUE (Including labor and aH materials including light fixtures) $ ~ ~J 7t9
~For applicable projeots, an Eleelric Installation verification form, signed by the Electrical Contractor, must be
attached. If not attaohed or not applicable, a separat~ Eleetdcal Permit ia
Electric Installation Verification
I
(Eleztrioal Contravtor Name)
(city)
(State) (Zip Code)
have l~on co~ to pm'form ol~aic installation work for
at the following address:
(Address where work will be performed)
The nature of the work consists of: ( .Cheok One or Deson~o the Nature of Work)
~on or new circuit for replacement Heating Plant ~mit/or A/C Condenser.
Reconnection or new circuit for replacement l~le~trio Water Heater or power vented
water heater.
Recormeotion of the Servi.c,z Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit ins~llation. Note: New Service
Remnne~on or n~w ~mfit for the mpla~emeat of other pmmanontly wired
lq~w ~ for flae addition of A/C to an ~ dwd//ng tm~t (houzo ortho
ol~izal outlet
Ot~ ·
The value of this work is $
thc rcconncctiml / jllstalh~on will be done ill COlllplJalll~ wilh m~ and Electric COde