HomeMy WebLinkAbout0128040-HVAC (furnace)
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OSHKOSH
ON THE WATER
Job Address 1631 DOTY ST
CITY OF OSHKOSH
No
128040
HV AC PERMIT - APPLICATION AND RECORD
Owner JANET R CRUZ
Create Date 12/04/2007
Contractor BLACK-HAAK HEATING Category 500 - ResL~~r:!!@L__Heati'2-~L~Ventilatlr!g__ Plan___ _______
Fuel ~_~~~___J D~oil _~==~J U_~~~!i~_=] D_~9JC1T~:===] D:_~Q1id_::=~:J
System D~e""-------_._.__.__J [~L~E!pJElc.e_______._.__.____! o Other
~~~~e~~~r_J C[Ra~Cl.~t::~:~J DS}~~rn~~=~] D-=A{~~~~"'=_: Vent
OE~~trl~:::::::] C:::rl9~Waf~f~-~ D-~s:::u.peT..:::::] D_:::c~~:._~ur~~~~J
Ch imney Type a~fiI~E.::~=:::::O:f.~irn neyEf:.-~:::::::IDlre'cC'{~n}::::.-::=:::O__~_q!)\J;p]~~~~':::'~::::J
Heat Loss ITAs Appro~_- .EXiSfulg-:.::::::::::::=::::O "'Lq!~2TIcab~-=~ Value ________
BTU Rate D:::~~~_=::==____=:O~~:::::.:::::::::==:::][QITlir=:::==::::~_1 Value
check #1M82---~-----1
UselNature ~FR / REPLACE GAS FURNACE, EIV SIGNED BY QUANTUM ELECTRICAL SOLUTIONS LLC **
of Work I
I
I
I
_._----_.._---~._-_._.j
Fees: Valuation $1,900.00
Issued By: m,&
Plan Approval ____~QQ
Permit Fee Paid $38.50
-~-----_..._... ...,-_._--~-
Date 12/04/2007
O_i='~~':1l_~~.<JIdedJ
Parcelld # 0305910000
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 (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
~
OfHKOfH
ON THE WATER
~xm~ \eel3~,6D
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 $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor varticivatinz in the Permit fee Account System and have adequate funds. check here
if yOU want this processed through your account n
** Advisory - For applicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by the homeowner) must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be retunted for completion.
DATE~
JOB ADDRESS \ \j~ \ DDtlj <st. ) DSbkts h
OWNER (JoJ,et CrU'b . . . . .
CONTRACTOR1A(l~~,[JJLV) +\fr^ll~ ~r, '
CHECK 0 ALL APPLICABLE
USE CATEGORY
~ingle Family DDuplex DMulti-Family
DRental
DCommercial
Dlndustrial
FUEL
b(Gas
DOil
DElectric DSolid
DSolar
SYSTEM
DNew
DOther
_~eplace
TYPE
iEForced Air DRadiant DSteam DA/C DVent DElectric DHot Water DSuppl. DCon. Burner
IS CHlMNEY BEING LINED ~o DYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS
BTU RATE
DChimney A
DAs Approved
DAs Per Plan
DChimney B
~xisting
DVariable
pqOirect Vent DOther
DNot Applicable
p(Other Value
DESCRIPTION/ SCOPE OF ALL WORK BEING DONE
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~U CIIIfth 4"MIiIl
PC 0.... 1110
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orlb ,:0.1.,.''''0
Ftx Ill:o.:!$-'O,.
Electric In stall ad Oil VerlDeadoD
(1) (We)
:p&"~_.__~_.frrfenyu'~ .
(Address) (City)
~.._-~~_._-~~
(State) (Zip Code)
have bee:n e(lntracted tope:rfonn electric installation work for lJ~_..
(Name of party contracted W) V
atthefQUowingadd:rlllss: \1;:0\ D~_..s+. ~~b.- ~ _........____.__.
( ddress wh~ work will 'be pe.rfonncd)
The nature of the work c:onsiatc; of: (Check One or Dc;er.!oo the Nature ofWl;1rk)
~ R.econnection or new circuit for replaeem.en.t H.1I$tini Plant MalQI" AfC Condenser.
R.e-connection or new circuit for replacement ElecmiC Water Heater.
Re~onnt(ltion Qfthe Service Entnmce Cable, Meter Box, alterat.iQJ1lS to receptacles 8Jld
liihting fixtures due to siding I soffit m!Jt&Uaaion. Note: Nt;W Service Entrance
Cables win require a aepa.rate permit.
Rcconnection or new circuit for other pennantntly wired. appliance.~ / fIxtures
Other
lL_ltI':YMIIW-._"
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....~.t_. />.Utll. _~_...
The vahle of this work is $
2SJ1.\~.
I hereby verifY this \!OrK win be performed by an employee otthill company and further verify the
recomlecticn / installation will be done in compliarn:e with mmufaeturcr ,Ind Electric cooe
requirements.
_~,J f~__f~~C?/t~_
(Print Name of Ot1'1eer)
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