HomeMy WebLinkAbout0096026-HVAC (a/c)
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OSHKOSH
ON THE WATER
Job Address 1849 ARIZONA ST
~.
CITY OF OSHKOSH
No
96026
HVAC PERMIT -APPLICATION AND RECORD
Owner KENNETH K KOEPPEN/LISA JEPSON
Create Date 07/16/2002
Contractor TENTH STREET STATION INC
Fuel I I Gas I Oil
System ~ New
U Forced Air U Radiant
I J Electric U Hot Water
Chimney Type U Chimney A () Chimney B
Heat Loss () As Approved () Existing
BTU Rate U As Per Plan () Variable
Category 501 - Residential-Air Conditioning Plan
I I Solar I Solid
D Other
l!J AlC U Vent
I J Con. Burner
. Not Applicable
1,1'] Electric
D Replace
U Steam
U Suppl.
() Direct Vent
. Not Applicable
. Other
Value 0
Value 2 ton
Use/Nature SFR/ Install 2 ton ale. *EIV form from Drexler Electric.
of Work
Fees: Valuation
Issued By: kYY1
$1,200.00
Plan Approval
$0.00
Permit Fee Paid
$23.00
Date 07/22/2002
D Permit Voided I
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address
924 OHIO STREET
OSHKOSH
WI 54902 - 0
Telephone Number 236-8770, MOBILE 7
if!4
~
OJHKOfH
ON THE WATER
City of Oshkosh
Division of Inspeclion Services
215 Church Avenue
POBox, 1130
Oshkosh WI 54902-1130
Office 920-236-5050
Fax, 920-236-5084
Electric .Installation Verification
(I) (We)
1) c<. t; )( L E"R !; l E CTt2.. \ (.
(Electrical Contractor Name)
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 / soffit installation. Note: New Service Entrance
Cables will require a separate permit.
Reconnection or new circuit for other permanently wired appliances / fixtures.
Other /J vf- W .
/1/ e-t-J C ~/zc.,u l7 H ~ l ~J4 -~ {1,,.-,,/0 ~ .../S'(' "'-
+-
The value of this work is $ /<10, cfJ
1 hereby verify this work will be performed by an employee of this company and further verify the
reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
~t+ILU f' 0. OR~ylcrZ
(Print Name of Officer)
. i ~~ V-Od-
(Date)
t,
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, VVI54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
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 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
Jfvou are a contractor participatinz in the Permit fee Account System and have adequaTe funds, check here
i ou want this rocessed throu h our account
DATE 7112-/0"L
JOB ADDRESS I e l1ct A-n'~ V\.G
OWNER . t~W\ .~ ~\.(5
CONTRACTOR lt~?~ 6Tzch'"-V\.
CHECK 0 ALL APPLICABLE
USE CATEGORY
~ingle Family DDuplex o Multi-Family
DRental
o Commercial
Olndustrial
FUEL
DGas
DOil
, ()Electric DSolid
DSolar
SYSTEM
~New
DOther
DReplace
TYPE
DForced Air DRadiant DSteam ~AJC DVent DElectric DHot Water DSupp1.DCon. Burner
IS CHIMNEY BEING LINED rjil'No DYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CIDMNEY TYPE
HEAT LOSS
BTU RATE
DChirrmey A
DAs Approved
DAs Per Plan
DChirrmey B
DExisting
DVariable
DDirect Vent i90ther
~Not Applicable
DOther Value Z-- 7c>V\.
DESClUPTION OF ALL WORK BEING DONE \ VvS tttd-- ~ k((:...-
VALUE (Including labor and all materials including light fixtures) $ '''Z-O'V. O'V
~~ $fZ3,~
ELECTlUCAL CONTRACTOR
ORrt' Electric Installation Verification form attachcd(J f Replacement)
Electrical installa/ion of new /replacement equipment shall be done by licensed conlraClOrs.
3/02