HomeMy WebLinkAbout0095897-HVAC (a/c)
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OSHKOSH
ON THE WATER
Job Address 1102 BISMARCK AVE
CITY OF OSHKOSH
No
95897
HVAC PERMIT -APPLICATION AND RECORD
Owner SALLY A DOBBINS
Create Date 07/16/2002
Contractor
RASMUSSEN'S HEATING & NC INC
Category 501 - Residential-Air Conditioning
Plan
Fuel
~ Gas I Oil
o New
U Forced Air U Radiant
I I Electric U Hot Water
U Chimney A () Chimney B
() As Approved . Existing
KJ As Per Plan () Variable
U Electric
D Replace
U Steam
I I Suppl.
() Direct Vent
~NC
I I Con. Burner
. Not Applicable
D Other
U Vent
U Solar
I Solid
System
Chimney Type
() Not Applicable
. Other
Value 0
Heat Loss
BTU Rate
Value 3 ton
Use/Nature t;FRI q53 Guenther St/ Replacing ale unit. *EIV form from Slim's Electric.
of Work
Fees: Valuation
$3,000.01
Plan Approval
$0.00
Permit Fee Paid
$51.50
Issued By:
Date 07/16/2002
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
Agent/Owner
Address 5154 DAVID DR
OSHKOSH
WI 54904 - 8850 Telephone Number 920-235-6569
--
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
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ON THE WATER
HVAC 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 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 permit fee, which ever is greater.
OR
If yOU are a contractor participatinf! in the Permit fee Account System and have adequate funds. check here
i ou want this rocessed throu hour accou
DATE 7-11-0')..
JOB ADDRESS 3$3
OWNER
CONTRACTOR RC\~Vr'l"S6 en' '$
CHECK ~ ALL APPLICABLE
USE CATEGORY
r$single Family o Duplex DMulti-Family
o Rental
o Commercial
o Industrial
FUEL
~Gas
DOil
DElectric DSolid
o Solar
SYSTEM
DNew
o Other
DReplace
TYPE
DForced Air DRadiant DSteam.p(AlC DVent DElectric DHot Water DSupp1.DCon. Burner
IS ClDMNEY BEING LINED ~o DYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CIDMNEY TYPE
HEAT LOSS
BTU RATE
DChimney A
DAs Approved
DAs Per Plan
DChimney B
IXExisting
DVariable
DDirect Vent o Other
DNot Applicable
~Other Value :3 To fQ
DESCRIPTION OF ALL WORK BEING DONE R tfdd(. \ Vf~ l~ Ie
U Vl\ 1-
$ "':l.. I") .f:, '" . Of)
VALUE (Including labor and all materials including light fixtures) ..,J" V' vV' ~
ELECTRICAL CONTRACTOR
OR ClElectric Installation Verification form attached(IfReplacement)
&trfcal'installation of new/replacement equipment shall be done by licensed contractors.
3/02
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10_'130
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08ice ~
Fax~
Electric Installation Verification
I (We)
S"Jo tn'S Elc:..<:.,+r,t:-
(Electrical Contractor Name)
~c, DB Da..Jcwo:wl Gr
(Address)
Oshhsh
(City)
\Vi
(State)
S4 'lei.{
(Zip Code)
have been contracted to perform electric installation work for ---IS o..Sn-t u ss en' ~ H V A<.r
(Name of party contracted to)
at the following address:
:"'15"3 G-ue'n-i'he'(' ~
(Address where work will be performed)
The nature of the work consists of: (9heck One or Describe the Nature of Work)
-X- Recmmection or new circuit for replacement Heating Plant and/or Ale Condenser.
Reeonnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Servi~ Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit lnstanation. Note: New Service
Entrance Cables will require a separate permit.
_ Reconneenon or new circuit for the replacement of other permanently wired
appliances I fixtures.
New circuit for the addition of AlC to an individual dwelling unit (house or the
individualsysteJn$'in a duplex Or condominium), including required service
electrical outlets.
Other
The value of this work is $ /50
I hereby verify this work will be performed by an employee oftbis company and further verify
the reeonnection I installation will be done in compliance with manufacturer and Electric code
~ts..
:DMt:J/~'dJ
(Print Name of cer)
7-1I-(J~
(Date)