HomeMy WebLinkAbout2007-HVAC (boiler)
G
OSHKOSH
ON THE WATER
Job Address 901 WASHINGTON AVE
CITY OF OSHKOSH
No
127118
HV AC PERMIT - APPLICATION AND RECORD
Owner FELICIA F JACOBSON
Create Date 10/04/2007
Contractor
MARK WEBER HEATING & COOLING IN
Chimney Type
Category 500 - Besi9_entia1:ljeatin~'{E?ntilati~9-__ Plan_______________
[]E1ec1ilC= O.::solar--------l U Solid ____J
o Replace--.J D~~~_ I
QStS8m ~ U AlC U_ Verit----J
OSUppl. I U Con. Burner
~g~=_Q Not Applicable ~
._~~~~PJ~!is:able __~ Value _,___
. Other Value
Heat Loss
LG~_~
[l New
U Forced Air 0 Radiant J
U Electric D Hot Water]
.~i~~______~imney B
KJ As Approved 0 Existing
o As Per Plan () Variable
D-OTI--~
Fuel
System
BTU Rate
Use/Nature SFR / Replace boiler. EIV provided by Electrical Construction Services. **DEBIT ACCT**.
of Work
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Fees: Valuation
$2,500.00
-- Tbiii;j
Plan Approval
$0.00
Permit Fee Paid
________ ___$47.5Q
Date 10/04/2007
Issued By:
D Permit Voided i
________. ___._..J
Parcelld # 0202580000
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
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 contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Agent/Owner
Address
1075 ISLAND ESTATE CT
OSHKOSH WI 54901 -1341 Telephone Number
235-1523
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (Le. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
ON THF WATFR
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
· AppIication(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 ou are a contractor artici atin in the Permit ee Account S stem and have ade uate unds check here
ou want this rocessed throu h our account
** Advisory - For applicable projects, an Electrical Installation Verification (ElV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by the homeowner) must be submitted
with the permit application. Applications submitted with'out an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
JOB ADDRESS 901 /A )~iNh ?ON'
OWNER ~J,q J(teo{J~
CONTRACTOR /"14'?J 1< h~ ~
DATE /0- g ,07
-
CHECK 0 ALL APPLICABLE
USE CATEGORY
~ingle Family DDuplex DMulti-Family
o Rental
o Commercial
o Industrial
FUEL
jf?t(G as
DOH
DElectric DSolid
DSolar
SYSTEM
DNew
DOther
~Replace
TYPE
DForced Air ~adiant DSteam DA/C DVent DElectric DHot Water DSuppl. DCon. Burner
IS CHIMNEY BEING LINED ~o DYes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ~himney A DChimney B DDirect Vent DOther
HEA T LOSS . DAs Approved DExisting DNot Applicable
BTU RATE DAs Per Plan DVariable DOther Value
CRIPTION / SCOPE OF ALL WORK BEING DONE t' ~~r OF~f<:j'f7A/C
lL.
VALUE (Including labor and materials) $ ~S tJD.. bU
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
07/07
City of Oshkosh
D;,'isloo QflnSpeClioll Services
215 Church A venue
PO B{l~ 1130
Osr~l,;osh WI $4903-1130
Office 920.236.5050
Fax 920-236-5084
Electric InstaUation Verification
I (We)
\ . _.. - I. {\. -"'~"";. '" . ~-"^, ...... ('-~ t, .~ \. (t
\':" .. "f (~i't '1 ;..lv,_. '\4C;,--'--.L-~~"" ("('J: y" ; --::-.)""~ ~'i i.o 1 \. ("T!.:::;~\ \- "~"'-.', "
(Electrical Contractor Name)
\-?~
(Address)
,.
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A-'
i' ' \~.., '\ i,: ,<,". ~~, ..1.
." __J- _""'... _~ oM -t
(City)
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\<->~_~/ 5;..-:n
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'_.J'-, {.J,(
(Zip Code)
7J.
h "",,:::~
\i~.1 -' C ,J..
(State)
have been contracted to perform. electric installation work for /'1 M K ~~ ~,
(Name of party contracted to)
at the following address: tqj))
~tT$tirNb /t)~,
(Address where work will be;performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
~ Reconne.ction or ne\\' circuit for replacement Heating Plant and/or pJC Condenser.
Reconnection or new circuit for replacement Electric Water Heater or pow'er vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to rec~ptacles
and lighting fixtures due to siding I soffit installation. Note: New Service
Entrance Cables \-viII require a separate permit.)
Reconnection or new circuit for the replacement of olher permanently wireq
appliances I fixtures.
New circuit for the addition of Ale 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 $__/~/)
r hereby verify this work will be performed by an employee of this company and further verify
the reconnection I installation ~vin be done in compliance with manufacturer and Electric code
reqUirements.
.....-....
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_ \~.~--~-?-~\t~~,=-~7~"'--_w-
(Sjgnature.9f~ompan! Officer)
(~.:f::L~2Y"' '\~~~.~4~~~::\...i~~
/Q.~~:~':2-.
(Date)
(Print Name of Officer)
5/02
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