HomeMy WebLinkAbout0099884-HVAC (furnace)OSHKOSH
ON THE WATER
.lob Address 404 S EAGLE ST
Contractor
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
GRANT SCHULTZ HEATING & COOLING
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner DONNA M MCKEON
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved ~ Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
99884
02/20/2003
Other
Vent J
Use/Nature SFR/Replace furnace. *EIV form from homeowner.
of Work
Fees: Valuation
Issued By:
$2,315.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$41.00
Date 02/20/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1411 S MAIN ST Oshkosh WI 54902 - 0
Telephone Number
(920) 216-1616
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-I 130
Phone (920) 236-5050
Fax (92(}) 236-5084
OdH QfH
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-I 128. Commencing work without permit(s) will result in fees being doubled orS100.00 plus the
normal permit fee, which ever is greater.
OR
[f .vou are a contractor part. i.c. ipa. ting in the Permi~ £~e Account System and have adequate funds, chec.k...~.e. Eg
if ~:° U want this processed through your account ~ -
JOB
ADDRESS
OW R '7'tr
CONtRAcToR cC , f'
CHECK [] ALL APPLICABLE
nCATEGORY
gle Family I"iDuplex i-]Multi-Family •Rental
I-ICommer¢ial
E]Industria~
FUEL ~3~3as []Electric [2Solid SYSTEM []New l~Replace
[]Oil I-}Solar []Other
ced Air •Radiant U1Steam OA/C •Vent OEl~tric
IS CI-HMNEY BEING LINED fl~No rqYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE •Chimney A l'3Chimney B
H~AT LOSS I-lAs Approved FlExisting
BTU RATE []As Per Plan []Variable
DESCRIPTION OF ALL WORK BEING DONE
•Hot Water OSuppl.
& MANUFACTURER
J~Direct Vent
[2Not Applicable
[]Other Value
[]Con. Burner
•Other
VALUE (Including labor and all materials including light fixtures) $ ~i~"~ ~
ELECTRICAL CONTRACTOR ~
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.
5/02
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Electric Installation Verification
(print homeowner(s) name)
(addrkss where work is to be performed)
accept the responsibility for performing the electrical work as stated below for the property listed
above.
The nature of the work consists of: (Cheek One or Describe the Nature of Work)
.Reeonneefion or new circuit for replacement Heating Plant and/or MC Condenser.
Reeonnection 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 permit.
~ Reeonnection or new circuit for the replacement of other permanently wired
appliances / fixtures.
. . New circuit for the addition o£A/C to an individual dwelling unit, including
required service electrical outlets. Note: Homeowners can only do their own
electric on a single family owner occupied home. Work on a condominium,
duplex, rental, or multi-use building would require a licensed master
electrician.
Other
The value of this work is $ ~ .~l K~. ~
I herebY verify this wore will be performed by me and further verify thc reconneetion /
installation will be done in compliance with manufacturer and Electric code requirements.
-~' Homeowner(s) Signature (Date)
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