HomeMy WebLinkAbout0126232-HVAC (furnace)
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U Solid
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In the performance of this work, I agree to perform all work pursuant to
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to conta9tthe easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature
"Agent/Owner"" "
Date
OSHKOSH
~ 08/13/2007 08:59
::: k'.U. ltOX lUll
Oshkosh. Wl )4903-1130
Phone (920) 23&-SOSO
.Fu. (920) 236-5084
19204251890
STEINBRUNER HEATING:
PAGE 01
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O~~R
HV AC PERMIT APPLICATION
All information after bold ca(t.~oric. m\W1 be provided.
Incomplete applKllrions will Dot be processed.
. Appticatioo(s) and fee(s) can be ~ught to City Ran, Room 205 or mailed to Inspection Services. pO Bo)!. 1128.
OshkOllh WI 54903-1128- Conttnencing work without permit(~) '~,;1I result in fees beiDa doubled or $100.00 plm t~
normal permit fee, whioh ever is greater.
OR
~(ynli art (J c~ntr!lcJI'" Da,..tiCj~(Jt"~ in III:, b'!!!Jj.J.1u "cco",'" Sxstem..9:.nd "!lye adequate fUfldr.. check 1r.~':..t
If'ipy' want ""$ ''''llCfssed t1.!.r/?JLh _~ur a ~ .
DATE~ ~~/3 -- Cf7
OWNli:R
CONTRACTOR
/~~ 111~~ __
IZ~ kJo/dt
s reO) B~JJb72-
JOB ADDRESS
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CHECK iJ ALL APPLICABLE
USE CATEGORY
DSinglc Family ODuplcx DMulti-Family
o Rental
OCommercial
DIndustrial
FUEL
~
DOil
DElectrtc DSohd
aSolar
SYSTEM
ONew
DOther
~lace
~ced Air ORadiant OSteam OAlC ClVent ClElectric []Hot Water []Supp1. aCon" Burner
IS CHIMNEY BEING V::NED ~ DYes - LINER SlZE,.._____-_ & MANUFACTURER
Noto: All chinmeys shall be ,\zed per the BTU's being venled.
cJllMNEY TYPE OCMmney A ~i_y B lJ[)iIoc' V d DOthcr
REA T LOSS OAs Approved xisting (JNot Applicable
BTIJRATE DAsperPlan DV;u-i3ble OOlherValue~q~ '8ru
D'ESCRIPTION OF ALL WORK BEING DONE~_~, kr~p.
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VALUE ~'_M{E_~() ~
ELECTRICAL CONTRACTOR _~, 8~~~/yL.c.__;-:---.~
o FO'l" applicable projects, an Electrio InstallatIOn Venrication fonn. si50ed by the Electrical Contractor, must N-
attached. If not attached or not applicable, a separate Electrical Permit is required.
'/02
08/13/2007 08:59
~
~
~ olJ~
19204251890
STEINBRUNER HEATING:
PAGE 02
Cil)' of OshkGSh
Division of lmpcclioo Seov;~n
2.1 j Cbun:h A "Cnuc
PO Box IUO
Od1kaell WI S490l.lI30
OffICe 920-236-$050
fill 9l0-U6-~
Electric Installation Verification
€.Le'-'f1e1 c. CfJjt\f.MJY IN~_
(Electrical Contractor Name)
5~?o CO()~eY. f'L.IJ~""~ ~t># UJJ1JlJeoJ",,~e- /.,{j)
(Address) (City) (State)
I (We) ~~ At!-
544 E3fo
. (Zip Code)
have been contracted to perfonn electric installation work for sm tJt;.e.UNC7e...
(Name of party contracted to)
I~~ )Jr~
(Address where work will be performed)
at the following address:
~
The nature of the work consists of: (Check One or Describe the Nature of Work)
~
Reconnection or new circuit for replacement Heating Plant and/or Ale Condenser.
Reconnection or new circuit for replacement Electric Water: Heater or power vented
water heater.
Reconnection of the Service Entrance Cable. Meter Box, alteratio.ns to receptacles
and lighting fixtures due to siding I soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reconnection or new circuit for the replacement of other permanently wired
appliances I fixtures. .
New circuit for the addition of NC to an individual dwelling unit (house or the.
individual systems in a duplex or condominium), including required service
eleCtrical outlets.
Other
?
The value of this work is $
I hereby verify this work will be performed by an employee oflhis company and further verify
the reconnect ion I installation will be done in compliance with manufacturer and Electric code
requirements.
~~ . SEu..A.e
(Print Name of Officer)
~P3/a7___
- , .
(Date)
re of Company Officer)
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