HomeMy WebLinkAbout0102895-HVAC (a/c)Contractor
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
OSHKOSH
ON THE WATER
Job Address 2203 JEFFERSON ST
ALL SEASONS QUALITY HTG & CLG Category 50'i - Residential-Air Conditioning
~ Gas I [] Oil ] L] Electric I ~ Solar
[] New I 121 Replac~ I
~ Forced Air j ~J Radiant ~J Steam I
I ,I Electric I ~ Hot Water I [] SuppL ~
~ Not Applicable
Owner WILLIAM/HEATHER MULLINS JR
Chimney Type [,~ Chimney A { ~ Chimney B ~..~ Direct Vent
Heat Loss ~, ~ As Approved ~.~ Existing ~ Not Applicable I Value
BTU Rate ~.~ As Per Plan (. ~ Variable ~ Other I Value
No
102895
Create Date 07/17/2003
Plan
I CT Solid ~
[] Other
LJTM [
Use/Nature FPJAddA/Cunitto existing fumace and duct system. *EIVformfromDrexler Electric.
of Work
Fees: Valuation
Issued By:
,250.00 Plan Approval $0.00 Permit Fee Paid
~[~ Permit Voided i
$24.50
Date 07/17/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 1661 IOWA ST OSHKOSH WI 54902 -0 Telephone Number (920) 426-8090
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
O/HKO/H
HVAC 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 participating in the Permit fee Account System and have adequate funds, .check here
i£¥ou want this processed through Your account [~
OWNER ~U~l t' l J i~C:,Lm i'3q tM I t'. S
CHECK [] ALL APPLICABLE
USE CATEGORY
~'Single Family [2Duplex
rqMulti-Faxnily E]Rental
r~Commercial
FlIndustrial
FUEL ~Gas F'lElectric FtSolid SYSTEM F1New []Replace
FI Oil [] Solar []Other
TYPE
FIForced Air DRadiant []Steam ~/AYC []Vent []Electric DHot Water []Suppl.
IS C~Y BEING LINED []No []Yes - LINER SIZE & MANUFACTURER.
Note: All chimneys shall be sized per the BTU's being vented.
[]Con. Burner
CHIMNEY TYPE
HEAT LOSS
BTU RATE
rqChimney A []Chimney B []Direct Vent
[]As ApProved UIExisting F1N0t Applicable
[]As Per Plan []Variable []Other Value
DESCmPTIO ALL WOaXBE G t
[]Other
VALUE (Including labor and all materials including light fixtures) $ ]]'~ ~"~(~, 0(-9
ELECT CAL CO TRACTOR
D For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
Electric Installation 'Verification
(We)
(Electrical Contractor Name)
(AddresS) fCity)
(State) (Zip, Code)
have been contracted to perform electric installation work for _/~ ~ Sc---~r$o~5
(Name of party contracted to)
at the £ollownig address:
(Address where work will be performed)
The namre of the work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
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 pemqit.
Recmmection or new circuit for the replacement o£ other permanently wired
appliances / fixtures.
_~ New circuit for the addition of AfC to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value o£this work is $.. /z~0 ~ o~
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
(S~gnatme of
(Print Name of Officer) (Date
5/02