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1'\ CITY OF OSHKOSH HEATING PERMIT
APPLICATION AND RECORD
Date -3 '~J- I 7 Application
~ 6il
N<.?
3612
Owner
Address
Building Use
Type of Fuel:
Gas Y Oil
Coal Electric
Other
Type of Heating System:
Forced Air (number)
Steam (number)
Unit heater (number)
.~
New heating system
Conversion Burner
/
Hot Water (number)
Gravity (number)
Replacement of:
, ./)A;yn~~
New Used
Calculated Heat Loss ~ ~
Size of Unites) I' I /J ~
Miscellaneous Work to Heating System
~~ ~~j'd.l LpJ~
G.~-? sf: :;-~ ~.
~ . ..s:-u
I. 1~?-j~AuJ~""~~'1~
The undersigned hereby applies for a permit to do the work herein described, according
to the plans and specifications herewith filed, and hereby agrees that such work will be
done in accordance with said description, plans and specifications, and in compliance with
ordinances of the City of Oshkosh and the state building code of Wisconsin.
Heating Contractor
Address
Valuation of Work
Electrical Contractor
18,'1: tj.
ti-r:~
(Signed)
Address
(By)
Address
Heating Inspector
Final Inspection
Owner
ctL.0nJ
Agent
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