HomeMy WebLinkAbout0123916-HVAC (boiler)
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OSHKOSH
ON THE WATER
Job Address 20 W SMITH AVE
CITY OF OSHKOSH
HVACPERMIT -APPLICATION AND RECORD
Owner DAVID G/ROXANNE M NELSON
Contractor THOMPSON HEATING AND COOLING S
Fuel ~ Gas UOil
System D New
U Forced Air I U Radiant
U Electric I ~ Hot Water
Chimney Type U Chimney A . Chimney B
Heat Loss K) As Approved () Existing
BTU Rate K) As Per Plan () Variable
Category 500 - Residential-Heating & Ventilating
U Electric
o Replace
U Steam
. U Suppl.
() Direct Vent
U Solar
U AlC
U Con. Burner
o Not Applicable
. Not Applicable
. Other
Value
Value
Use/Nature SFR 1 Replace boiler, add back flow preventer, auto feed. Electrical contracor is Quality Electric.
of Work
Fees: Valuation
Plan Approval
$0.00
Permit Fee Paid
Issued By:
D Permit Voided I
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
described in this per . ppli tion within an easemen e City strongly urges the permit applicant to contact the ease
holder(s) and to cure n cessary appr val starting such activity.
Signature
Oat
Address
901 OTTER
OSHKOSH
WI 54901 - 0
Telephone Number 920-426-3095
No
123916
Create Date 03/23/2007
U Solid
Other
U Vent
$46.00
Date 03/23/2007
arcelld # 1517860000
ork
ent
3/'2-3),
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Perm t Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), yo r Name and Phone
Number. Unfess specified otherwise, we will assume the project is ready at the time the request is rec ived. Work may
continue if the inspection is not performed within two business days from the time the project is read
City of Oshkosh
Division ofInspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920)236-5050
Fax (920) 236-5084
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ifHKOfH
ON 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 S 'ces, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being do b~ed or $100.00 plus the
normal permit fee, which ever is greater.
OR
I 'ou are a contractor artici atin in the Permit ee Account S stem and have izde
if vou want this processed through vour account n
check here
JOBADDRESS 2& uJ d.u/rH- ~
. OWNER !yJv/f) /~ k ~~ .. '
. CONTRACTOR ~P0Pjc7/'-J kYf 7l^-{J
. if
DATE . J '2/() 7
CHECK It[ ALL APPLICABLE
USE CATEGORY
tWSingle Family o Duplex o Multi-Family
DRental
o Commercial
DIndustrial .
FUEL
IT4Gas
DOi!
DE1ectric DSolid
DSolar
SYSTEM
DNew
o Other
ep1ace
TYPE
DForcedAir DRadiant DSteam DNC o Vent DElectric $otWater DSupp. DCon. Burner
IS CHIMNEY BEING LINED ~o DYes - LlNER SIZE
Note: All chittmeys shall be sized per the BTU's being vented.
CHIMNEY TYPE
BEAT LOSS
BTU RATE
DChimney A
~As Approved
DAs Per Plan
r3Chimney B
o Existing
DVariable
DDirect Vent DOther
DNot Applicable
~OtherValue
DESCRIPTION OF ALL WORK BEING
ELECTRICAL CONTRACTOR
o For applicable projects, an Electric Installation Verification form, signed by the Elec cal Contractor, must be
attached. If not attached or not applicab~e, a separate Electrical Permit is required.
,$ 24/lJ. rU
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