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0 CITY OF OSHKOSH No 124011
OSHKOSH HV AC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 3221 MOCKINGBIRD WAY Owner CHET WESENBERG Cr ate Date 11/10/2006
Contractor GRANT SCHULTZ HEATING & COOLING Category 500 - Residential-Heating & Ventilating Plar
Fuel 1,11 Gas I I J Oil I LJ Electric I LJ Solar I OSolid I
System o New I D Replace I Dc ther I
l!J Forced Air I U Radiant I U Steam I U AlC ~ U Vent I
LJ Electric I LJ Hot Water I I J Suppl. I LJ Con. Burn~
Chimney Type () Chimney A () Chimney B . Direct Vent () Not Applicable I
Heat Loss . As Approved () Existing () Not Applicable I Value
BTU Rate . As Per Plan () Variable () Other I Value
Use/Nature NSFR /INSTALL NEW HVAC SYSTEM FOR NEW HOME **debt acct
of Work
Fees: Valuation $5,400.00 Plan Approval $0.00 Permit Fee Paid $91.00
Issued By: ~W Date 04/02/2007
D Permit Voided I Pc rcelld # 1336110000
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 we rk
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easeme t
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 55 CRIMSON LN OSHKOSH WI 54902 -0 Telephone Number (920) 216-1616
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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 (Le. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), YOl r Name and Phone
Number. Unless 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 ready.
:;:
:::
Grant Schultz
920-237-4959
-. p.1
City of Oshkosh
Division ofInspection Services
P.O. Box 1130
Oshkosh, vvr 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications wi][ not be processed.
· AppHcation(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Servic s, PO Box 1128,
Oshkosh W!54903-1128.Commencing work withoutpermit(s) will result in fees being doubl d or $100.00 plus the
nonnal permit fee, which ever is greater.
OR
I
e Account S !stem and have ade ual
check here
DATE
JOB ADDRE~S j {} fJ I If? octl1~ b,y~ Wd-ij
OWNER~€'.e'l1bt~ !Jr6~;k{;'.f
CONTRACTOR (lrcmf .2(0(.( lie if tJ 1 Air,. u~c:
CHECK 0" ALL APPLICABLE
USE CATEGORY
'}1Single Family DDuplex OMulti-Family
o Rental
DCommercial
o ndustrial
FUEL
~Gas
0011
oElectric DSolid
DSolar
SYSTEM
~New
DOther
DRep ace
pE
~Forced Air
o Radi ant
OSteam DAle o Vent o Electric DHot Water DSuppL
Con. B umer
IS CHIMNEY BEING LINED DNa DYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHI.MNEY TYPE
HEAT LOSS
BTU RATE
DChimney A
~_As Approved
-mAs Per Plan
DChimney B
o Existing
DVariable
WDirect Vent o Other
DNat Applicable
OOther Valuc
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and materials) $
5 c.; 0 0 o!;'
ELECTRICAL CONTRACTOR
Cl For applicable projects, an Electric lnstallation Verification form, signed by the Electrical ontractor, must be
attached. 1fnot attached or not applicable, a separate Electrical Permit is required.
10/0'1