HomeMy WebLinkAbout0099861-HVAC (pellet stove)OSHKOSH
ON THE WATER
Job Address 1104 MINNESOTA ST
Contractor OWNER
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Owner RUBEN/VIRGINIA BORGARDT JR
Category 503- STOVES AND FIREPLACES
Fuel E~-Gas T
System [] New
~ Forced Air J
E~~ctdc
[] Oil
1 L~ Electric I I I Solar
I [] Replace I
~_d Radiant J bd Steam j ~ NC
[] Hot Water ] E~-~ppl- 1 ~--Con- Burner I
Chimney Type
Heat Loss
BTU Rate
Use/Nature
No 99861
Create Date 02/18/2003
Plan
~J Solid I
Other r
Vent
~ Chimney A (.~ Chimney B ~1 Direct Vent ~ Not Applicable
~ As Approved {_) Existing O Not Applicable I Value 0
~ As Per Plan (..~ Variable O Other I Value
I FPJ Installing a pellet stove. All work shall comply with State building codes and Manufactures installation instructions. Earth Sense/
nergy Systems will be installing the unit.
of Work
Fees: Valuation
Issued By:
$2,500.00 Plan Approval $0.00 Permit Fee Paid
[] Permit VoidedI
$42.50
Date 02/18/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
0 Agent/Owner
Address 1104 MINNESOTA ST OSHKOSH WI 54902 -6445 Telephone Number
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
7'79
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
O./'HKO/H
ON THE WATER
· 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
I£ vou are a contractor participating in the Permit fee Account System and have adequate funds, check here
i£ Fou want this processed through Four account ["]
JOB ADDRESS
OWNER
CONT C OR
DA'I~
CHECK [] ALL APPLICABLE
USE CATEGORY
~ngle Family F1Duplex
F1Multi-Family
F1Rental
[:]Commercial
Fllndustrial
FUEL F1Gas I-IElectric FISolid SYSTEM
F1Oil []Solar
TYPE
[:]Forced Air F1Radiant []Steam F1A/C F1Vent •Electric
IS CHIMNEY BEING LINED []No []Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented
[]New []Replace
-.[2Other
[]Hot Water El'Suppl. []Con. Burner
& MANUFACTURER
CI-HMNEY TYPE
HEAT LOSS
BTU RATE
[]Chimney A
F1As Approved
[]As Per Plan
FlChimney B
[]Existing
[]Variable
12'~irect Vent
-Ul~ot Applicable
[]Other Value
[]Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02