HomeMy WebLinkAbout0123236-HVAC (boiler)
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OSHKOSH
ON THE WATER
Job Address 903 BROOKWOOD CT
CITY OF OSHKOSH
No
123236
HVAC PERMIT -APPLICATION AND RECORD
Owner ALAN/LEAN ORE ROMMELFANGER
Create Date 01/19/2007
Contractor PALISADES SHEET METAL
Fuel U Gas UOil
System o New
U Forced Air U Radiant
U Electric l.!'::J Hot Water
Chimney Type D Chimney A D Chimney B
Heat Loss o As Approved () Existing
BTU Rate KJ As Per Plan C) Variable
Category 500 - Residential-Heating & Ventilating Plan
U Solar U Solid
o Other
U AlC U Vent
U Con. Bumer
. Not Applicable'
U Electric
o Replace
U Steam
U Suppl.
() Direct Vent
. Not Applicable
. Other
Value
Value
Use/Nature SFRI Replace boiler. Electrical contractor Schafer Electric. No EIV submitted.
of Work
Fees: Valuation
$6,900.00
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Plan Approval
$0.00
Permit Fee Paid
$113.50
Issued By:
Date 01/19/2007
o Permit Voided I
Parcelld # 1603280103
In the performance of this work: I agree to perform all work pursuant to rules governing 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
AgenUOwner
Address
1475 RACINE ROAD
MENASHA
WI 54952 - 0
Telephone Number (920) 729-1282
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (Le. 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 timethe request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
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'f\ \JJFROJR
. . ON THE WArEll
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Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903-1130
Fax # (920) 236-5084
Phone (920) 236-5048
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ECEIVED
All
HVAC PERMIT APPLICATION JAN 1 92007
fields/information ~fte:: bold. categories must be provi~ADTMI=NT OF
Incomplete appl1cat1ons w111 not be processed ''''t''iI\~r\I!.Hj' ,n i...
19q7!r04~ITY DEVELOPMENT
DATE
JOB ADDRESS 903 Brookwood Ct
OWNER . Alan Rommelfanger
CONTRACTOR
palisades Sheet Metal
,
CIRCLE ALL APPLICABLE
USE CATEGORY ~GLE FAM~~ DUPLEX
FUEL GAS OIL ELECTRIC
SYSTEM , NEW ~EPLAC~
TYPE FORCED AIR RADIANT
-ELECTRIC ~ ~
IS CHIMNEY BEING LINED LINER SIZE
,r'fote: All chimneys shall be sized per the BTU's being ven~~d.
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CHIMNEY TYPE
MULTI-FAMILY
COMMERCIAL
INDUSTRIAL
SOLAR
SOLID
OTHER
STEAM
Alc
VENT
SUPPL.
CON. BURNER.
MAN(JFACTURE.R
CHIMNEY A
CHIMNEY B
. DIRECT VENT
OTHER
HEAT LOSS
AS APPROVED
EXISTING
NOT APPLICABLE
BTU RATE
AS PER PLAN
VARIABLE
OTHER VALUE
NATURE OF WORK:
Install Boiler
VALUE (Including labor and materials) $ 6900.00
ELECT.RIC1l-..:t. CONT:R..~CTORSchaf~r Electric _
Electrical installation of new/replacement equipment shall be done by licensed
contractors.
Valuation
Fees
d(\
\f \t ~
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\ fJ-0
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$ 0 to $1, 0 0 0 . 0 0 ....__................................................................................................................................$ 2 0 . 0 0
$1 , 000 . 01 to $10, 000 . 0 0...............................................................................................................$ 20 . 0 0 for firs t
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$1 0 , 0 0 0 . 0 1 to $ 2 5 , 0 0 0 . 0 0 ............................................................................................................$ 15 5 . Oaf or fir s t
$10,000.00 plus $1.0? per $100.00 valuation or part thereof
-rve r $ 2 5 , 000 . 0 0.....................................................................................................................................,.$ 3 0' 5:" 0 0 p I us $ 0 . 50
,~: .. . per $100.00 valuation or part thereof
. Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.
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OJHKOfH
ON THE WATER
City of Oshkosh
Division of Inspection Services
215 Church Avenue
PO Box I 130
Oshkosh WI 54902.1130
Office 920-236-5050
Fax 920.236-5084
Electric Installation Verification
P1"tWe)
J"'r~ /"~ Iu.
(Electrical Contractor Name)
~.1 {, if (J~ ? d ;4
(Address) 7
7JU4ta./..
(City)
t(/L"
(State)
5Y9:>-~
(Zip Code)
have been contracted to perform electric installation work for p~ ~ ~~ '
(Name of party co acted to)
at the following address:
9p.3 ~d~ If
(Address where work will be perfoimed)
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 NC Condenser.
Reconnection or new circuit for replacement Electric Water Heater.
Reconnection of the 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.
Reconnection or new circuit for other permanently wired appliances I fixtures.
Other
The value ofthis work is $ ul) . rl
I hereby verify this work will be performed by an employee ofthis company and further verify the
reconnection I installation will be done in compliance with manufacturer and Electric code
requirements.
/(:::'~mpanY Officer)
~ 7~,.. .s::. A It -( e r-
(Print Name of Officer)
/..../~~~7
(Date)