HomeMy WebLinkAbout0088527-HVAC (furance & A/C)
o
OSHKOSH
ON THE WATER
Job Address 1127 MERRI LL ST
"erN-OF OSHKOSH
No
88527
HVAC PERMIT - APPLICATION AND RECORD
Owner PATRICK S ZULLNER
Create Date 05/15/2001
Category 502 - Residential-Both
I Electric
D Replace
U Steam
I I Suppl.
e) Direct Vent
Plan
Contractor RASMUSSEN'S HEATING & NC INC
Fuel I J Gas I Oil
System D New
U Forced Air U Radiant
U Electric U Hot Water
Chimney Type . Chimney A () Chimney B
Heat Loss () As Approved . Existing
BTU Rate () As Per Plan e) Variable
I Solar I Solid
D Other
U NC U Vent
I I Con. Burner
() Not Applicable
() Not Applicable
. Other
Value
Value 80,000
Use/Nature ~FR / REPLACE FURNACE AND NC
of Work (No electric permit required - received installation verification signed by Hoehne Electric)
Fees: Valuation
$5,000.00
Plan Approval
$0.00
Permit Fee Paid
$80.00
Issued By:
~
Date 08/21/2001
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
AgenUOwner
Address
5154 DAVID DR
OSHKOSH
WI 54904 - 0
Telephone Number 920-235-6569
Ma~ 11 01 07:57p
Scott Noe
920-232-0455
p. 1
~
OJI-KOJH
ON 1,..n .....'Hl;..
Division of Inspection Services
215 Church Avenue
P.O. Box 2230
Oshkosh. WI 54903-1130
Fax # (920) 236-50&4
Phone (920) 236-5048
HVAC PERMIT APPLICATION
All fields/information after bold categories must be provided.
Incomplete applications will not be processed.
DATE 5'-14"01
JOB ADDRESS II~ 7 f'\<"r'n\\ 51-.
OWNER Y(J. TZU \\ \'\C.:('
CONTRACTOR R~~Vl'\vssen:S HVAc..
CIRCLE ALL APPLICABLE
USE CATEGORY ~GLE FAMILJ)
FUEL (?;S::> OIL
DUPLEX MUDTI-FAMILY
COMMERCIAL
INDUSTRIAL
ELECTRIC SOLAR
SOLID
SYSTEM
NEW
~~
@RCED AIR
ELECTRIC
~EPLACE)
OTHER
TYPE
RADIANT
STEAM
@ VENT
CON. BURNER
HOT WATER
SUPPL.
v 3q
IS CHIMNEY BEING LINED Te5 LINER SIZE
Note~ All chimneys shall be sized per the BTU's being vented.
MANUFACTURER F Ic')J { J(~
CHIMNEY TYPE
CCHIMNEY .9
AS APPROVED
CHIMNEY B
UXISTINV
VARIABLE
DIRECT VENT OTHER
BTU RATE
AS PER PLAN
NOT APPLICABLE
OTHER VALUE g()J tx:Jo
HEAT LOSS
l~ATURE OF WORK:
VALUE (Including labor and materials) $ $MQ. 00
ELECTRICAL CONTRACTOR Hoc!. hne.
Electrical installation of new/replacement equipment shall be done by licensed
contractors.
Valuation
Fees
$ 0 to $1, 0 (} 0 . 0 0 ........................................._.............................................................................._......__..$ 2 0 . 00
$1 , 00 0 . 0 1 to $10, 000 . 0 0 ........_......__.........._._..................................................................._........$ 2 0 . 00 for first
$1,000.00 plus $1.50 per $100.00 valuation Or part thereof
$10,000.01 to $25,000. 00............................................................................................................$155.00 for first
$10,000.00 plus $1.00 per $100.00 valuation or part thereof
Dve r $ 2 5, 00 0 . 0 0........................................._....................._............................................................._.....$ 3 0 5 . 00 plus $ 0 . 5 0
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, which ever is
greater.
Ma~ 11 01 07:581"
Scott Noe
920-232-0455
1".2
~
~
_THE __r:R
Ot,yof~
DivisiaA..r~~
21sc::1IlIIdiA-
fOfl(lIl.1Ult
QsWoIlS1t '\'11 S49lR-1130
QIIio>;~~
F.lct ~2-~
~-
~
""
- :.~
Electric Installation Vermeation
(l)(We) HOEhne. E"1ec..'\-r\c..
(Electrical ContraCtor Name)
. ,*,21 E. Dtr\-t4.~iO
(Address)
(}~YO
(City)
\.VI
(State)
sc.fQ63
(Zip Code)
have been contracted to perfoxm electric iDstallation work fOT R6.~""U5Se;." 5 H V Ae-
(Name of party COlltraCted to)
at the following address:
11,17 l'1c'yr, 1\ ST:
(Address where wodt wiD be performed)
The natnre of the wmk CO""~ of: (Check One or Describe 1be Nature of Work)
. ~ ReconnectiOB or new circuit fur r:eplaamcnt Beating Plant aodiOT AJC Condenser. -,
Recowection or new circuit for repJ.aceme:nt Ek:ctric Water Heater.
Rec0nnec6.on oftbe SeIvice Ennance ~ Meter Bo~ altelalions to receptacles and
Jigb6ng fixtm'eS- due to siding I soffit insta1Jation- Note: New Service Entrance
Cables will require a~* permit.
Reconnection .oruew:circuit forofi1<<penn2DP.l1tiywiml aw~ I fixtures.
Other
-.-.~~.. ----
...~;:-';:'~-:":~::~"'.,;,,,,,,,.
The value oft1Us work is $~;5 d. O~__
I hereby verify this work. will be perfmmed by an employee of this company and furt.her verify the .
reconnection I ins:alialion will be done in compliance withmanufadurer and Electric code
requirexnents- .-,..----... h'---- ._---..--
~~~ /~
(Signature ofCmnpaDy Officer) -
ad ~~tH
(Print Name of Officer)
_ 5-}'I -01
(Date)