HomeMy WebLinkAbout0128303-HVAC (furnace)
o
OSHKOSH
ON THE WATER
Job Address 1640 WESTERN ST
CITY OF OSHKOSH
No
128303
HVAC PERMIT - APPLICATION AND RECORD
Owner TODD AlNICOLE L MCKAY
Create Date 12/31/2007
Contractor BLACK-HAAK HEATING
Fuel ~ Gas UOil
System o New
~ Forced Air U Radiant
I J Electric U Hot Water
Chimney Type Chimney A Chimney B
Heat Loss o As Approved . Existing
BTU Rate KJ As Per Plan C) Variable
Category 500 - Residential-Heating & Ventilating Plan
U Electric ~
o Replace
U Steam :=J
U Supp!. I
I J Solar U Solid
n Other
U AlC U Vent
I J Con. Burner
Direct Vent Not Applicable
C) Not Applicable Value
. Other Value
Use/Nature ISFR / REPLACE FURNACE, EIV SIGNED BY QUANTUM ELECTRICAL SOLUTIONS INC **check #16722
of Work
Fees: Valuation $5,000.00
Issued By: OmS"
Plan Approval
$0.00
Permit Fee Paid
$85.00
Date 12/31/2007
o Permit Voided I
Parcelld # 1211170000
In the performance of this work, I agree to perform all \Vork pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of whicr 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
i
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
~nr\\t fee <it '60,00
HV AC PERMIT APP~ICA TION
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
Ifvou are a contractor varticivatinf! in the Permit fee Account Svstem and have adequate funds. check here
if vou want this processed through vour account n
** Advisory - For applicable projects, an Electrical Installation Verification (EIY) 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
\~ ''OlD \ D1
JOB ADDRESS. \ \]4D \N'{>~km G~.) ()(\n \<()~~
OWNER N\CD~ ~~
CONTRACTOR 10'. - ." .fLlk1I~~
i
DEe 3 1 2007
CHECK rtr ALL APPLICABLE
USE CATEGORY
tp,Single Family DDuplex DMulti-Family
o Rental
DEPARTi'IlE:\\i r OF
COMMUNITV DEVELOPrt:ENT
INSPECnON
o Commercial Dlndustrial
FUEL
~as
DOn
DElectric DSolid
D Solar
SYST:E:M
DNew
o Other
~Replace
TYPE
ijForced Air DRadiant DSteam DA/C DVent DElectr~c DHot Water DSuppl. DCon. Burner
IS CHIMNEY BEING LINED DNo f1;J.Yes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE DChimney A DChimney B iXIDirect Vent DOther
HEAT LOSS DAs Approved ~Existing DNot Applicable
BTU RATE DAs Per Plan DVariable ~Other Value
DESCRIPTION I SCOPE OF ALL WORK BEING DONE \fJ\S-\lill \ n~ (1 ~ a (Q..ffiQJI\ t-
9U&{UJ!VlflCPn ,
VALUE (Including labor and materials) $ DD OD ~ 00
ELECTRICAL CONTRACTOR (for projects not reqllidngan EIVForm) QU nJ\ttt UY\(\ fDh1 01\ 3)t LLttDn,S
07/07
~
07R<01H
OM '~e ....n~
City (lro*'*00I11
tl~kolI ~tl""'"tl4ft s.~.*
1150l1ll't.bA~
l'O 1';0. u,o
o.,*<>.~ WI 5>11102.1'30
0. .2~:U"50sc)
'!Ill 1I:1,(M..6.JGI4
Electric Installation VerUlcatloD
(I) (We) ~wu1tlAm .t~l ~ctY1C.a.L ~~\ui'~ l LC.
(Rlectrloal CQntractol Name!.)
E.O,~U1l e:'ffiW11\~__._ Of m.
(Addres.~) (City) . (State)
~qy~
(Zip Code)
have been c\)ntrt\cted. to perfonn electric in$uHation work, for ~~1a_.
(Name of party contnu::ted tC>;J
aathefoUowmgaddK:ss: 'LQ4D 'Ne~'S;b~ll~~ __.
(Adthess wh~fe work will be IHrlonned)
The nature ofthe work coMitits of: (Chock One or Describe the Nature ofWorlc)
...1::.. Reconnection or pew cireuit for replacement Heating Plant and/or Aie CCll1denaeT.
ROCQnne.:ttQh Of new circult tor repl~Illenl Electric Wik:t Heater.
Reeonnection o!the Service Entrance Ciblei Meter Box. alte.rn.hofli!l to receptacles and
li.ghling fixtures due to siding I soffit iru;tal111.ticm.. Note: New Set"Vicc Entrance
Cables will require a separate permit.
Recl)mection or new circuit for other pemumently wired eppH$flccs / fiXt'uTOli.
Other
I
'~~n007-
The value of t.l1is work is $
1.00. ~-'
..aJ__ l [;;:::'~}\~-:"'~";~~~~~'r;" C;F-'-
COfvlMUNITY DE\jELOP~liENT
INSPECTION DiVISION
I hereby veritY this work will be performed by an employee of this company Me fw1:her verify the
reconnec;tion I instaUation witl be done in compliance with manufil.CtW"el and Electric code
requirements.
J (' .sbt' P {> fer ~ Cl ..v
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(Print Name ofQffieer)
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