HomeMy WebLinkAbout0104046 HOSHKOSH
ON THE WATER
.lob Address 1080 N WESTFIELD ST
Contractor MARX MECHANICAL
Fuel
System
Gas J ~J Oil
New ~
Forced Air
Electric
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Radiant
Hot Water
Owner EVERGREEN RETIREMENT COMM INC
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA
Heat Loss I~ As Approved
BTU Rate I~ As Per Plan
Chimney B ~) Direct Vent O Not Applicable I
~) Existing O Not Applicable I Value
~ Variable ~ Other I Value
No
Create Date
Plan
L~ Solid
104046
09/09/2003
Other
Vent J
Use/Nature
of Work
Replace furnace with 75m btu input. *EIV form from Beez Electric.
Fees: Valuation
Issued By:
$2,800.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$47.00
Date 09/09/2003
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 4535 STATE ROAD 91 OSHKOSH WI 54904 -6304 Telephone Number
(920) 235-6510
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, Wt 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
RECEIVED
SEP 0 9 £0O5
DEPARTMENT OF
HVAc~ [~r~R~'To N
All information after bold categories must be provided.
Incomplete applications will not be processed.
O/HKO/H
· Application(s) and fee(s) can be brought to City Ha!l, 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 participatin~ in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account
JOB A~)D~ESS lOgO
CONTRACTOR H i:¢-m
CI][ECK [] ALL APPLICABLE
USE CATEGORY
I~[Single Fmnily [2Duplex [3Multi-Family
[3Rental [2Commercial [3Industrial
~UEL ~Gas [3Electhc F1Solid SYSTEM [3New ~Replace
[3Oil [3Solar [3Other
TYPE
J~tForced Air [3Radiant [3Steam mA/C [3Vent E]Electric
IS CH I M]N'EY BEING LIArED [3No IXlYes - LINER SIZE ~t'
Note: All chimneys shall be s/zed per the BTU's being vented.
[3Hot Water F1Suppl. ECon. Burner
& MANUFACTURi~R FUe¢- L-
CHIMNEY TYPE
HIgAT LOSS
BTU RATE
[3Chimney A
r-lAs Approved
CIAs Per Plan
FlChimneyB
EIExisting
F1Variable
nDirectVent
[3NotApplicable
[3Other Value
[3Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials including light fixtures) $ c;~ ~ 0O ,0
ELECTRICAL CONTRACTOR ~7__
[] For applicable projects, an Electric Installation Verification form, signed by the Electr/cal contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
Electric Installation Verification..
have been contramed to p ,erferm ele~riz inst~Im[on work for _MarxJVlechanic_~,
The mture o£ ihe work consi~'/s d': (Cheek One or Describe the Nature of Work)
Keconnecfion or new ckcu~t for replacement Heating Plant mad'or AJC Condenser.
Keconnectioa of the Servien Entrance Cable, Met~ Box, alterations to receptacles and
lighting fixtures due ~o siding / soffit installation. Note: New Smqce Entrmaee Cables
Kecom~eot~o~. or ne~' d~rcuk for other permaaent.y ~red applmnces / fixture&
Other
I hereby verify ,ki~. ,z~ork v l! b~: 2~,,:g~J~ed by a~ employee of this company and further verify the
requkemen~$.
(SLmm'~..re of Company