HomeMy WebLinkAbout0091292-HVAC (furnace)
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OSHKOSH
ON THE WATER
Job Address 2470 HICKORY LN
CITY OF OSHKOSH
No
91292
HVAC PERMIT - APPLICATION AND RECORD
Owner MICHAEL D / MELANIE J VANDENBERG
Create Date 11/14/2001
Contractor RASMUSSEN'S HEATING & AlC INC
Fuel ~ Gas L I Oil
System D New
~ Forced Air U Radiant
L I Electric I I Hot Water
Chimney Type U Chimney A . Chimney B
Heat Loss KJ As Approved . Existing
BTU Rate U As Per Plan . Variable
Category 500 - Residential-Heating & Ventilating Plan
I Solar I Solid
D Other
U AlC U Vent
U Con. Burner
I Electric
o Replace
U Steam
U Suppl.
C) Direct Vent () Not Applicable
() Not Applicable Value
() Other Value
Use/Nature SFR/ Replace furnace. *EIV form from Hoehne Electric.
of Work
Fees: Valuation
Issued By: K vY\
$4,700.00
Plan Approval
$0.00
Permit Fee Paid
$75.50
Date 11/14/2001
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
Agent/Owner
Address
5154 DAVID DR
OSHKOSH
WI 54904 - 8850
Telephone Number 920-235-6569
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Division of "tn8pec:ti.on services
. 215 Cbuxch A"...
P.O. ~ 1130
0Sb1c.0sh. tn 54903-1130
FaX' (920) 236-5084
Phone (920) 236-5048
HVAC PSmaT APPLiCATiON
All fields/information after bold categories must be provided.
Incomplete applications will not be processed.
DATE 1J.'''/~-O\
JOB ADDRESS ;:)'-170 t\ \ c;..ker'f Ln
OWNER M. \ \( c:- \/ Cl.~ e..r"\ C\ ~Y' ~
CONTRACTOR RA.~Vhu5.~....n'.s .l:-IVA c..
CDtCLE ALL APPLICABLE
USE CATEGORY (!INGLE FAM~ DUPLEX MULTI -FAMILY COMMERC:tAL INDUSTRIAL
FOEL ~ OIL ELECTRIC SOLAR SOLID
SYSTEM NEW C REPLAcE5 OTHER
TYPE CFORC~ RADIANT STEAM A/C vE:NT
ELECTRIC HOT WATER SUPP!'.. CON. BURNER
MANUFACTURER
IS CHIMNEY BBJ:NG LINBD ~ LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
~!C>
aSTIN~
(VAR:fABLE ...~
Cur t'\o..<:..e-
CJtDINEY Tn'E
CHIMNEY A
DIRECT VENT
OTHER
HEAT LOSS
AS APPROVED
NOT APPLICABLE
BTU RATE
AS PER PLAN
OTHER VALUE
NATURE OF WORK:
,J:n~\\
VAx.UE (Inc1.uc;iing l.abor and material.s) $ L/ 7 ()Q
ELECTRICAL CONTRACTOR I-Io.eh"c. EJc:.G......r tc-
Electrical installation of new/replacement equipmen~ shall be done by licensed
contractors.
Valuation ~
$0 to $1,000.00_..
_--"_"'..Ir
..$20.00
J.__.....4..
$1,000.01 to $10,000.00.. .$20.00 for first
$1,000.00 plus $1.50 per $100.00 valuatio~ or part thereof
$10 I 000 . 01 to $25,000.00- .. .. __ . , ". ...- ....". ...$155.00 for first
$10,000.00 plus $1.00 per $100.00 valuation or part thereof
Over $25,000.00
. __.. .. . ,.$305.00 plus $0.. 50
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
..
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OItTIIE ~
CilY af()sb1rosh
DiftDoaa(JmpecIilaSenitD
21S a.dI A-
1'0 Box 1130
()sIIbsIt WI S4902-1130
0fIicc 9'lO-236.s050
F.& 920-2]6-SlII4
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Electric Installation V erificatiOD
(l) (We) ~Q;;' hr'\c!.. Elu.-t..-\(:..
(Electrical Contraetor Name)
have been contracted to perform electric installation work for R6.~ ~u ~Sc.rn 5 ~ H V Ac... -
,
(Name of party contracted to)
at the fonowing address: d t.J 76 H I c...k.o 1'"'1 L Y\ .
(Address Where wodt win be performed)
. ';ll E. Dtn+&.,. ,0
(Address)
Ol""\rtl
(City)
\.VI
(State)
s"1{'3
(Zip Cocle)
The nature of the worlt consists of: (Check One or Descn"be the Nature of Work)
. X Reconnection or new circuit for tepJacemeot Ilea1i"8 Plant andior Ale Condenser.
Reconnection or new circuit foTreptacem.ent El.ecttic Water Heater.
Reconnection oftbe Service E.ntranCe Cable, Meter Bo~ alterations to -receptacles and
lighting fixtures due to siding I soffit ~ Note: New Service :EntIance
Cables will require a separate permit.
Reconnection or new. circuit for other peunsmently wiIed appliances I fixtmes.
Other
-=
The value of this work is $ . / d5 I a9
I hereby verify this work will be performed by an employee of this company and further verify the
reconnection I installation will be do~ incompliance with manufacturer and Electric code
requirements.
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(Signature of Company Officer) .
t ,f...f. i dJJ>f.
(Print Name ofOfticer)
Ii-l~-ol
(Date)