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OSHKOSH
ON THE WATER
Job Address 3034 SHADOW LN
Contractor COMFORT SOLUTIONS LLCIONE HOUR
CITY OF OSHKOSH
Na
124168
HVAC PERMIT -APPLICATION AND RECORD
Owner JASON L GOEBEUAMY S FARMER
Create Date 04/09/2007
Category 502 - Residential-Both__
Plan
I
Fuel
UOil
U Solar
Heat Loss
[~LGas _
o New
l~Lforced Air
O:_Electric
D3~F!mney A
(TAs Approved
D~_~s Per Plan
U Electric
o Replace
U Steam
U Suppl.
. Direct Vent
System
BTU Rate
U Radiant
U HotWater
() Chimney B
. Existing
() Variable
Chimney Type
~ AlC
U Con. Burner
0_ No~~~plicable
() Not Applicable
. Other
]
I
Value
Value
Use/N.at.ure FR 1 REPLACE FURNACE AND ADD 2 TON AlC SYSTEM (Electrical work being done by Van Ert Electric)
of Work I .<
I
I
I
L_____
$56.50
Fees: Valuation $3,100.00
Issued By: ~\..A \
Plan Approval
$0.00
Permit Fee Paid
Date 04111/2007'
o Permit Voided I
parcelld # 1519621200
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 itis not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Agent/Owner
Address 5165 GREEN VALLEY RD
OSHKOSH
WI 54904 - 9794 Telephone Number 920-982-3323
Ta schedule inspectians please call the Inspectian Request line at 236-5128 nating the Address, Permit Number, Type .of
Inspectian (i.e. Faating, Service, Final, etc.), Access inta Building if Secure (haw da we gain entry), your Name and Phane
Number. Unless specified .otherwise, we will assume the praject is ready at the time the request is received. Wark may
cantinue if the inspectian is nat perfarmed within twa business days'fram the time the praject is ready.
51 5& . @.
~63(o't
3/J{
I,. 3
Cit"j of Oshkosh
Division of Inspection SerVices
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
~ I;,
C!l 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 perrllit fee, which ever is greater.
OR
If YOU are a contractor varticipating in t1LLE.ermit fee A ccount System and have adequate-1jn1d'iL_LhfJ:.Js here
if you want this vrocessed through vour account rJ '
DATE~~ .:_9_l.-...
JOB ADDRESS <~6L\ S\,c-.dOl0 ~a..r<\Jl-
OWNER :s- <3L~ V\ G 0 eJ.o ~ \
CONTRACTOR C__O~~-r-'-\-' SC~\CY\ ~
CHECK 0 ALL APPLICABLE
USE CATEGORY
~ingle Family o Duplex DMulti-Family
o Rental
o Commercial
OI,ndustrial
FUEL
~Gas
OOil
OElectric DSoIid
OSolar
SYSTEM
DNew
DOther
E:Replace
TYPE
,.EForced Air DRadiant DSteam ~C OVent DElectric OHat Water DSuppl. DCan_ Burner
IS CHIMNEY BEING LINED ONo ~y es ~ LINER SIZE 3S1
Note: All chimneys shall be sized per the BTU's being vented,
& MAN1JFACTURER__~~
CHIMNEY TYPE
REA T LOSS
BTU RATE
DChimney A
DAs Approved
DAs Per Plan
DChimnev B
~Exjsti:1g
OVariable'
l8birect Vent o Other
DNot Applicable
~Other Value .-::lQ~______
DESCRIPTION OF ALL WORK BEANG DONE
~\~ ~VVlro. ~~
6> \~ 'S~~ o...nJ... ~S:Dk.
exd.d. ~{C J s~-k-W\,
fO \<:. ~ (l <MsL.
~ 'TO"C"\ ~(G
VALUE (Including labor and materials) L-3+tOD . ~
ELECTRICAL CONTRACTOR V~n...Lr+- ,-
o For applicable projects, an Electric Inst8.11ation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
10/04