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OSHKOSH
ON THE WATER
CITY OF OSHKOSH
No
97393
HVAC PERMIT - APPLICATION AND RECORD
Job Address 2728 HAMILTON ST
Owner CREATIVE CUSTOM HOMES
Create Date 07/17/2002
Contractor VANS HEATING & AlC INC
Fuel 1,(1 Gas I Oil
System o New
~ Forced Air U Radiant
I I Electric I J Hot Water
Chimney Type Chimney A Chimney B
Heat Loss . As Approved () Existing
BTU Rate . As Per Plan () Variable
Category 500 - Residential-Heating & Ventilating Plan
I J Solar
I Solid
J Electric
o Replace
U Steam
I I Suppl.
Direct Vent
U AlC
I I Con. Burner
Not Applicable
() Not Applicable
() Other
Value
o
Value
Use/Nature NSFRI Furnace & ductwork installation. * Job #117691
of Work
Fees: Valuation
Issued By: ~ r^
$4,014.00
Plan Approval
$0.00
Permit Fee Paid
$66.50
Date 09/19/2002
o 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 525 BUTLER ST
DEPERE
~ 54115 -5426 Telephone Number (920) 336-2816
k~&k~
~
OJHKOJH
ON THE WATER
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
;g 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 .
l~vou are a contractor artici atino in the Permit ee Account S
if'vou want this processed throuf!h vour account n
check here
JOB ADDRESS J7d.2
OWNER U-ea. f, /) 'e-
CONTRACTORYO h ~
Anm,'/lvr. Jjye~f
G s 10 /l-j J-Io /J1 e J
l/-e cd-, t1j ~ fh '" ~r1d,
DATE fj-3/ -0.:1..
CHECK li1 ALL APPLICABLE
USE CATEGORY
8Single Family DDupl(;x
o Multi-Family
o Rental
o Commercial
o Industrial
FUEL
U(1Gas
DOil
DReplace
DElectric DSolid
DSolar
SYSTEM
~New
o Other
TYPE
~Forced Air DRadiant DSteam DNC DVent DElectric DHot Water DSuppl.DCon. Burner
IS CHIMNEY BEING LINED ~No DYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE
HEA T LOSS
BTURATE
DChimney A
mAs Approved
~As Per Plan
DChimney B
DExisting
DVariable
DDirect Vent o Other
DNot Applicable
DOther Value
DESCRIPTION OF ALL WORK BEING DONE ~ftcu"-<- <:J cb.-tcftiJ.JfU'/G /l7sktl6hM
t n (\ eu J (: 0 /\. .s ?r- VCt: h 0 /J ,. 1'1- ra 1'"\ C /,
VAL UE (Including labor and all materials including light fixtures) $ q. /f) I 'I ~
ELECTRICAL CONTRACTOR
3/02
OR 0 Electric Installation Verification form attached(lfReplacement)
Electrical installation of new/replacement equipment shall be done by licensed contractors.