HomeMy WebLinkAbout0120200 H
e
OSHKOSH
ON THE WATER
Job Address 1941 OREGON ST
CITY OF OSHKOSH
No
120200
HVAC PERMIT -APPLICATION AND RECORD
Owner RICKEY UDEBORA BURT
Create Date 06122/2006
Category 502 - Residential-Both
U Electric
o Replace
U Steam
I J Suppl.
Plan
Contractor PREMIUM AIR INC
Fuel I~ Gas
System rJ New
l!J Forced Air
U Electric
Chimney Type Chimney A
Heat Loss . As Approved
BTU Rate . As Per Plan
I J Oil
U Solar
U Solid
o Other
U Vent
Chimney B
() Existing
() Variable
Direct Vent
l!J AlC
I J Con. Bumer
Not Applicable
U Radiant
I J Hot Water
() Not Applicable
() Other
I
J
Value
Value
Use/Nature =j::R / REPLACE FURNACE AND AlC EIV PROVIDED BY PREMIUM AIR lNG-ONE HOUR
of Work
Fees: valu~ 0 $4,912.80
Issued By:
Plan Approval
$0.00
Permit Fee Paid
$80.00
Date 06/22/2006
o Permit Voided I
Parcelld # 1406390000
In the performance of this work, I agree to perform all work pursuant to rules goveming the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Agent/Owner
Address
5165 GREEN VALLEY RD
OSHKOSH
WI 54~04 - ~J94___ Telephone Number 920-982-3323
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
'r~-drj
~
OJHKOfH
ON lHE WATER
City of Oshkosh
Division ofInspection Services
2 J 5 Church A venue
PO Box J 130
Oshkosh WI 54903-1130
Office 920-236-5050
Fax 920-236-5084
Electric Installation Verification
'l1em\u-m.Ir.(', ~C.
,
(Electrical Contractor Name)
SIloS ~ 'ic.\~>Y 'Rc\ O~\(oS~ VJI 9t:~
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for l=< ,c...'?- + ~\e Bu.-r t
(Name of party contracted to)
atthefollowingaddress: m Or~V1 S\-) osh)<.o~h WI- 54<1o~
" (A ress where work will be performed)
I (We)
The nature of the work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or AlC Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection ofthe Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding I soffit installation. Note: New Service
Entrance Cables will require a separate permit.
X Reconnection or new circuit for the replacement of other permanently wired
". ... ..." ." appliances I fixtures,_
~--New circuit for the addition of AlC to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $~ !la).
I hereby verifythis work will be performed by an employee of this company and further verify
the reconnection I installation will be done in compliance with manufacturer and Electric code
requirements,
flJJJ6 ~
(Signature of Company Officer)
/V;~/lOk IJ~(~
(Print Name of Officer)
& It? 10&
,
(Date)
5/02