HomeMy WebLinkAbout0103086-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
1717 CRYSTAL SPRINGS
RASMUSSEN'S HEATING & NC INC
I¢1 Gas I [ I Oil
[] New I
L~J Forced Air LJ Radiant
I I Electric I I I Hot Water
Chimney Type ~.) ChimneyA
Chimney B
Owner MR/MRS WAYNE H ZASTROW
Category 502 - Residential-Both
Electric I I I Solar
Replace J
~J Steam j L~ NC
I ,,,,J suppl. I ~J Con. Burner
(,.) DirectVent (..) Not Applicable
Heat Loss ~...) As Approved ~1 Existing
BTU Rate ~ ~ As Per Plan ~.) Vadable
Not Applicable I Value
Other I Value
No 103086
Create Date 07/24/2003
Plan
I [ IS°lid I
[] Other ~
Vent j
0
60m
Use/Nature [SFR/Replace furnace and NC. *ElY form from Slim's Electric.
of Work
Fees: Valuation $5,128.00 Plan Approval $0.00 Permit Fee Paid $83.00
Issued By: Date 07/24/2003
[] Permit Voided
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number 920-235-6569
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.
Fax (ir20) Z;~-SO~
OYH OYH
HVAC PERMIT APPLICATION
~dl infonmtion ~ boht catogofies must be provided.
· Application(s) and fee(s) ca~ be brought to City Hall, Room 205 or mailed to Inspection S~w-ices, PO Box 1128,
Oshkosh WI 54903-1128. Co,,-~ing work without pmmR(s) will result in foes being doubled or $100.00 plus fig
normal permit fee, which eve~ is greater.
OR
~f you are a COntractor partiei_uatin~ in the Permit fee Account System and have adeauate funds, cl~eck here
ff Vo~ want this oroce$~ed throul~h your account ~]
OWNER
DATE
C~a~:CK I~ ALL APPLICABLE
USE CATEGORY
[Nginglo Family KlDuplex
ElMulti-Famfly EIRental
VICOmm ercial
VlZudustrial
FUEL I~as [3Electric ~Solid SYSTEM
E]Oil EISolar
E]New [i~eplace
DOther
O/tot Water OguppL OCon. Burner
(We)
(Electrical Contrac~m- Name)
(Address)
(City) (Zip Code)
tYAc ,
~ame of party ~n~t~ ~)
(Afl~ wh~ ~ ~ ~ p~o~)
have been contraoted to per/bxm alecUio instal~ion work for
at the following address:
The naim'e of the work oonsisls off (.Check One or Demibo the Nature of Work)
',///Reeooneelion or new oircoit for replacement Htming Plant and/or A/C Condenser.
__ Reeonneetion or new ch~uit for replacemant Electric Water Heater or power vented
~ Reconnection of the Service Eniranee Cable, Meter Box, alterations to receptacles
and lighting fixturas due to sjalng / soffit installation. Note: New Service
Ena~ Cables will require a separate pert, fit.
~ Recommction or now oirouit for ttm replacement of oflmr pemmmmtly wired
appliances / fixtures.
__ New circuit for the eddifion of A/C to an individual dwelling, unit ~aouse ortho
elecUicel omte~
Th~ yalue ofthls work is $ 3.qO,°°
I hereby verify this work will be performed by an employee of this company ~d fo.,thor verify
the reconnection / installation will be done in compliance with mamltheturer and Electric code