HomeMy WebLinkAbout0123980-HVAC (furnace-a/c)
G CITY OF OSHKOSH No 123980
OSHKOSH HV AC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1120 HERITAGE TRL Owner LEVI CrrONI RODENSAL C eate Date 03/29/2007
Contractor DRUCKS PLUMBING & HEATING CO IN( Category 502 - Residential-Both Plan
Fuel ~ Gas I UOil I U Electric I U Solar I U Solid I
System o New I o Replace I 0 )ther I
~ Forced Air I U Radiant I U Steam I ~ AlC I U Vent I
U Electric I U Hot Water I U Suppl. I U Con. Burner I
Chimney Type KJ Chimney A () Chimney B . Direct Vent () Not Applicable I
Heat Loss K.J As Approved . Existing C) Not Applicable I Value
BTU Rate K.) As Per Plan . Variable C) Other I Value
Use/Nature ISFR / REPLACE FURNACE AND AlC, EIV SIGNED BY TRIUMPH ELECTRIC
of Work I .
Fees: Valuation $WO Plan Approval $0.00 Permit Fee Paid $115.00
Issued By: ~ Date 03/29/2007
o Permit Voided I Pa celld # 1314580000
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 wo k
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easemer t
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address POBOX 355 MENASHA WI 54952 -355 Telephone Number 920-426-2654
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit lJumber, Type of
Inspection (i.e. 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 time the request is rece i ed. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
03(!~/07 09~17 FAX 7220851
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Electrie. Installation Veritieatiob.
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The nature oftb.t!: work consists of~ (Check One or Describe the Nature of Work)
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ReconneC'tiou or new circuit for replac:ema Hea.cmg Plant and/or
R.econnection 01" new circuit for teplMt!!mem.t Electric Water Heate1:'.
Reconnection offbc Service BmratI.ce Cable. Meter Box, alterations
lighting fixtUres due to sidIDg I soffit installation. Note: New S
. Cables wiIl require a separate permit.
R.eco:tmection or new c.irouit f.or other perm.an.ently wifed appliances fixtures.
Other
t::q q'if
ip Code)
have bcen'eon:ttacted to per:f'Otttl. E!lectric instalIatio:l1 work for
. 't (Nam,of'p~c
at1h~fonowingaddress= \ \~() \-~_f\l a e' Tffi\ \ UJ
(Address where work will be per:forwed)
The value of this work is $ d' () O. (J 0 .
r hereby verifY this wott will be performed by an employee oftbis company and
reconr.u~ction I installation win be done in compUabU with manufacturer and. Electri.
requirements.
~~
(SignatUre ~Cot:nPan.y Officer)
fr\ 4_C:ij; ~C ~a 1\
(print amc of'omcer)
-IS-D?
(Date)
~
OJH<OiH
ON THE W^TER'
Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903-1130
Fax # (920) 236-5084
Phone (920) 236-5048
HVAC PERMIT APPLICATION
All fields/information after bold categories must be prov ded.
Incomplete applications will not be processed.
DATE
JOB ADDRESS 1I2fS) (..JI?{U: 7~~ 71LL
OWNER Lf::II( f2er::t~5.A-'-
CONTRACTOR {j/UA.C/CS Pce,""-13 r ,4:;?;.
CIRCLE ALL APPLICABLE
USE CATEGORY ~ ~
FUEL ~ OIL
;?~1
1'" ·
ttSVY
DUPLEX MULTI-FAMILY
COMMERC AL
INDUSTRIAL
ELECTRIC SOLAR
SOLID
SYSTEM NEW ~ OTHER
TYPE ~ RADIANT STEAM rFlJ; VENT
ELECTRIC HOT WATER SUPPL. CON.
IS CHIMNEY BEING LINED LINER SIZE N!A
Note: All chimneys shall be sized per the BTU's being ventec;l.
OTHER
CHIMNEY TYPE
CHIMNEY A
CHIMNEY B
~~
~
NOT APPLIC
HEAT LOSS
AS APPROVED
BTU RATE
AS PER PLAN
OTHER VALUE
NATURE OF WORK:
~lACk FuA-NAet: AN~ Ale-
VALUE (Including labor and materials) $ )00() ~
ELECTRICAL :CCl~RACTOr,_ Th()~{;tPt1 fu~TiU.L.
Electrical installation of new/replacement equipment shall be done by Ii ensed
contractors.
If r;
Valuation
Fees
$ 0 to $1, 000 . 0 0 .......................................................................................................................................$ 20 . 0
$1, 000 . 01 to $10, 00 0 . 0 0 ...............................................................................................................$ 2 0 .' 0 for firs t
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10,000.01 to $25,000. 00.....................................................................................................:......$155. 0 for first
$10,000.00 plus $1.00 per $100.00 valuation or part thereof
Over $ 2 5 , 000 . 0 O....:..........................................~.......................................................................................$ 305. 0 pI 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, whic ever is
greater.
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