HomeMy WebLinkAbout2007-HVAC (system)
e CITY OF OSHKOSH No 123962
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3245 S WASHBURN ST Owner BERGSTROM FOX VALLEY INC reate Date 03/28/2007
Contractor HURCKMAN MECHANICAL IND., INC. Category 512 - Ind. & Comm-Both Pan X3-1895-0107-H
Fuel ~ Gas I UOil I ~ Electric I U Solar I U Solid I
System o New I D Replace I 0 Other I
l!J Forced Air I U Radiant I U Steam I l!J AlC I l!J Vent I
U Electric I .. U Hot Water I I I Suppl. I U Con. Burner I
Chimney Type D Chimney A () Chimney B . Direct Vent () Not Applicable I
Heat Loss . As Approved C) Existing () Not Applicable I Value
BTU Rate . As Per Plan () Variable C) Other I Value
Use/Nature HVAC system as per State Trans ID # 1367093 to include RTU's, make-up air, ventilation, radiant heat, ductwo k, and vehicle exhaust.
of Work
Fees: Valuation $180,000.00 Plan Approval $0.00 Permit Fee Paid $1,085.00
Issued By: Date 03/28/2007
D Permit Voided I I arcelld # 1365010000
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 '" ork
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easem ~nt
holder(s) and to secure any necessary approvals before starting such activity.
Signature Oat
Agent/Owner
Address P.O. BOX 10977 GREEN BAY WI 54307 - 977 Telephone Number 920-499-8771
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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. Unless specified otherwise, we will assume the project is ready at the time the request is rec eived. Work may
continue if the inspection is not performed within two business days from the time the project is read, .
City of Oshkosh
{~. Division oflnspection Services
P.O. Box 1130
Oshkosh, WI 54903-1] 30
Phone (920)236-5050
Fax (920) 236-5084
MAR 2 6 2007
'-
HV AC 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 Servi es, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being daub ed or $100.00 plus the
normal permit fee, which ever is greater.
OR
LLY-Oll are a contractor arlici at in in the Permit ee Account S stem and have ade ua e unds. check here
if' VOIl want this processed throuzh your account n
DATE 3., 2. "0-=1
JOB ADDRESS 3Vc...'S S ,Wf\Si4'i3>O'E!'i 5.....
OWN E R '~?e7s;i\"\C ,,,,,- c..,,'l.'1'a ~;f\"ll c::. N
CONTRACTOR \.\..u''YL~~~ MUctA~..;l'..cALX""C
CHECK ~ ALL APPLICABLE
r
USE CATEGORY
OSingle Family ODuplex
DMulti-Family
DRental
)dCommercial
Industrial
FUEL
){bas
DOil
~Iectric DSolid
DSolar
SYSTEM
DNew
DOther
TYPE
~orced Air ~Radiant DSteam ~A/C DVent DElectric DHot Water DSuppl. DCon. Burner
IS CHIMNEY BEING LINED DNa DYes - LINER SIZE
~ote: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS
BTU RATE
DChimney A
~s Approved
[Q1\s Per Plan
I!1thimney B
DExisting
DVariable
DDirect Vent DOther
DNot Applicable
DOther Value
DESCRIPTION OF ALL WORK BEING DONE
? UN,
~o"'(.:..
V A LUE (Including labor and materials) $ \ eo ,Oc:t.).. <:,e;!
r'-"
I
ELECTRICAL CONTRACTOR '" .. ~\'V"--'-( --- .... ~\..c....
CJ For applicable projects, an Electric Installation Verification form, signed by the Electric I Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
10/04