HomeMy WebLinkAbout0127957-HVAC (furnaces)
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OSHKOSH
ON THE WATER
Job Address 1328 WAUGOO AVE
CITY OF OSHKOSH
No
127957
HV AC PERMIT - APPLICATION AND RECORD
Owner ROBERT J/LORI R FULMER
Create Date 11/08/2007
Contractor
BLACK-HAAK HEATING
Category 500 - ~_~~d_~r1tl~l~HeaJif!.9_& Ventilatir1.fL_
Plan
BTU Rate
~ GaS:::---l ITQ!C_~=] U Ele~~~__=.J
o New ~ [?] Replace ~
~ Forced Air U Radiant ---] O}teani--] U NC ~
U Electric D~ter== U Suppr--=-] U Con~l!.I"r:!EiD
U~himne~_._Q_~himne~__.~=~.==CIDJr~c[ VenJ=____.I'!()!}\pi>R~?l>~_=~]
O_As- Approve~=~=-~~=-_E_~i~tJ.r1-g:=:-=-==-~=~OH~U\ijTi~a~I'; =~~=~ ' Value
-=~I~r Plan_.=~_===-~II'l~.ria!2I~~. . Value
0: Sola;-=-i OUSolid -~.J
D_()~h_er___~_j
o Vent__J
Fuel
System
Chimney Type
Heat Loss
UselNature [DUPLEX 1 REPLACE FU-RNACESONBOTHSioE.S.On.-HE:OuP[EX,EIV-SfGNEDBYOUANTorVn~U~cfRTcALS6LUfjONS~TLc
of Work I**check #16353
I
I
I
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Fees: Valuation $3,500.00
Issued By: ~~
Plan Approval $0.00
Permit Fee Paid ________JE>2.50
Date 11/27/2007
D_.!'ermit Voi~~
Parcel Id # 0205790000
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
PO BOX 7075
APPLETON
WI 54912 - 7075 Telephone Number 920-757-9990
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. 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, VVI54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
~
OfHKOfH
ON THE WATER
Wffi \-\' tet ~ lO~ 150
HV AC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
. 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
If ~ ou are a contractor artici atin in the Permit ee Account S stem and have ade
i ou want this processed through vour account n
** Advisory _ For applicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be petformed by the homeowner) must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
JOBADDRESS i~~'&'\N~DO Mt \ Otmto;:;Y1
OWNER ~~\J fll\mt(
CONTRACTOR11l00vYt\L\LlY) m{^n~~_1Jl c '
DATE \\ \1-' D1
CHECK 0 ALL APPLICABLE
USE CATEGORY
DSingle Family 19ouplex DMulti-Family
DRental
DCommercial
Dlndustrial
FUEL
ttQ'Gas
DOn
DElectric DSolid
DSolar
SYSTEM
DNew
DOther
~Replace
TYPE
,~Forced Air o Radiant DSteam DA/C OVent DElectric DRot Water DSuppl. DCon. Burner
IS CHIMNEY BEING LINED DNolQYes - LINER SIZE W\\ & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE
HEAT LOSS
BTU RATE
DChimney B
J81Existing
DDirect Vent b{Otherlf{\G\,<;)DnC\;Vl~~)_
DNot Applicable ~-}
DOther Value
~~
VALUE (Including labor and materials) $ 0000 ,00
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
au
07/07
~
OJHI<O.fH
ON THE WATER
City of Oshkosh
Division of Inspection Services
2] 5 ChW"Ch Avenue
PO Box] 130
Oshkosh WI 54902-1130
Office 920-236-5050
Fax 920-236-5084
Electric Installation Verification
(I) (We) ~UL\fthlVY\ e10ctv1~) LLt
. (Electrical Contrnctor Name)
P, D . Bn~ ~1t 1 i' ~f1\\J1;tl~W1- 54 C14 ~
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for C '
(Name of party contracted to)
at the following address:
The nature ofthe work consists of: (Check One or Describe the Nature of Work)
~
Reconnection or new circuit for replacement Heating Plant and/or AlC Condenser.
Reconnection or new circuit for replacement Electric Water Heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles and
lighting fixtures due to siding / soffit installation. Note: New Service Entrance
Cables will require a separate permit.
Reconnection or new circuit for other permanently wired appliances / fixtures.
Other
The value of this work is $
{}-OO_~(,>
I hereby verify this work will be performed by an employee ofthis company and further verify the
reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
jt'~~e Q e.f-ers 01'/
(Print Name of Officer)
1/ / 7 /0 ")
'(D~te )