HomeMy WebLinkAbout0128127-HVAC (furnace)
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OSHKOSH
ON THE WATER
Job Address 1421 COLUMBIA AVE
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
No
128127
Owner JED AlANN M FELKER
Create Date 12/11/2007
Contractor BLACK-HAAK HEATING
Fuel I~ Gas I J Oil
System o New
~ Forced Air U Radiant
U Electric I J Hot Water
Chimney Type D Chimney A () Chimney B
Heat Loss ~) As Approved . Existing
BTU Rate ~) As Per Plan () Variable
Category 500 - Residential-Heating & Ventilating Plan
U Solar I J Solid
o Other
U AlC U Vent
U Con. Burner
I J Electric
~ Replace
U Steam
U Suppl.
. Direct Vent () Not Applicable
() Not Applicable Value
. Other Value
Use/Nature SFR / Replace furnace. EIV provided by Quantum Electrical Solutions.
of Work
$2,300.00
t~
Plan Approval
$0.00
Permit Fee Paid
$44.50
Fees: Valuation
Issued By:
Date 12/11/2007
o Permit Voided I
Parcelld # 1217530000
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
'Vtrfn ii C~@- $ Y 4 . 5)
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 participatinf! in the Permit fee Account System and have adequate funds. check here
if you want this processed through your account n
** Advisory - For aIJPlicable 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 returned for completion.
DATE \~'6'tn
()~h
,
I
DEe 11 2007
DEPARTIVIENT OF
COMMUNITY DEVELOP~'1ENT
INSPECTION SERVICES DI\/TSIO\\l
CONTRACTOR
CHECK 0 ALL APPLICABLE
USE CATEGORY
'f&Single Family DDuplex DMulti-Family
DRental
o Commercial
Dlndustrial
FUEL
aGas
DOil
DElectric DSolid
DSolar
SYSTEM
DNew
o Other
~Replace
TYPE
M,Forced Air DRadiant DSteam DA/C DVent DElectric DHot Water DSuppl. DCon. Burner
IS CHIMNEY BEING LINED~oOYes ~ LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE DChimney A DChimney B l(Oirect Vent o Other
HEAT LOSS DAs Approved ~xisting DNot Applicable
BTU RATE DAs Per Plan DVariable ~Other Value
DE~CIUPTION I ~COPE OF ALL WORK BEING DONE~\ acect~u~ ,fuJrr1 ace.. \ h
Ws\l Vl~ \]O(Yvt.. . ' ..
',' ". 0
VALUE (Including labor and materials) $ ~DOO I D
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
Quurr\tl\~ ~,€ d1r1 illJ
SO\ Ll11Dl1S LLC .
07/07
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Electric Installation Verification
(I) (We) _ ~Uo.o
]>.-4D. ~C~ 'tkl \
(Address)
~e
(City)
\J~ .. .__.~ 5~W1L
(State) (Zip Code)
(Name of party tontra.cted
at the follQwing address: \ 4 ~ \ OJtu.ro ~,o ~.. I f\Sf\Kt')sh
(Addras ~ will beperlormed)
ha'1l'e been contracted to perfonn electric installation work for'
The nat1lft; of tho work consists or: (Check One or Deseribe the Nature of Work)
.::i-
Reoouuection or new circuit for replacement Heating Plant and/or Ale Condenser.
RecoMection or new circuit for replacement Electric Water Hnter.
Reconnectioll of the Service Entrance Cable, Meter Box, a)terationJ to recepu.ch~, and
Jishdng fixtureli dl.le 10 sidinll Goffit installation. Note: New Service Bntrance
Cables win require a separate permit.
Reeonnection or new circuit for other permanently wired. appliances I fil>1.tures.
Other
(OO,od
--'"-efPJ!,KFi'>lEi'H OF
CO\'iiMUNITY DEVELOP~~ENT
INSPECTION SERVICES DIVISION
The value ofthls work is $ -"'-
I hereby verify this work will be perfonncd by an employee of this company and further verify the
rlo'!lconneetion f installation wi.U be done in compliance with manufactwer and Electric ttooe
requirements,
JfS>(> _&If' '.JoN
(print Name of Officer)
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