HomeMy WebLinkAbout0131532-HVAC (boiler)/~`~ '~, CITY OF OSHKOSH No 131532
OSHKOSH
ON THE WATER
Job Address 1234 MOUNT VERNON ST
Contractor RYF HEATING & A/C INC
Fuel / Gas Oil
System [] New ~ !,
Chimney Type
Heat Loss
BTU Rate
Use/Nature
of Work
HVAC PERMIT -APPLICATION AND RECORD
Forced Air Radiant
Electric / Hot Water.
Chimnev A Chimnev B
Owner CARL A BUCHOLTZ Create Date 07/14/2008
Category 500 -Residential-Heating & Ventilating Plan
Electric Solar Solid
^/ Replace ~ ^ Other
Steam A/C Vent
Suppl. Con. Burner
Direct Vent Not Applicable
Value
Value
~ As Per Plan ~) Variable '~ ~ Other ~
K, tIV SIGNED 6Y
Fees: Valua ' n $3,000.00 Plan Approval $0.00 Pennit Fee Paid
Issued By:
II ^ Permit Voided
$55.00
_ Date 07/14/2008
Parcelld # 1506870000
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 450 '' WINNECONNE WI 54986 -450 Telephone Number 920-582-4451
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To schedule inspections please call the Inspection Request line at 238-5128 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 pertormed within two business days from the time the project is ready.
City of Oshkosh '
Division of Inspection Services ~~
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920)236-5050
Fax (920)236-5084
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
** Advisory -For applicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by the homeowner) most 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 retarned for completion.
DATE ~ /~ ~~
JOB ADDRESS ~~3 ~{ J~? ~ ; v~~ h, o w
~a-i' ~ /J 4 c h n <
/~ /'~C' ~"itlC,
CHECK ®ALL APPLICABLE
USE CATEGORY
Single Family ^Duplex ^Multi-Family ^Rental
i
FUEL ~SDGas ^Electric ^Solid SYSTEM
^Oil ^Solar
I
TYPE
^Forced Air ^Radiant ^Steam ^A/C ^Vent ^Electric
IS CHIMNEY BEING LINED ^No
Note: All chimneys shall be sized per the 1
CHIMNEY TYPE ^Chimney A
HEAT LOSS ^As Approved
BTU RATE ^As Per Plan
^Commercial
^New
^Other
^ Industrial
(Replace
,Hot Water ^Suppl. ^Con. Burner
-LINER SIZE_ ~ & MANUFACTURER Z - ~~c~
being vented.
6(Chimney B ^Direct Vent ^Other
^Existing ^Not Applicable
^Variable ^Other Value
DESCRIPTION /SCOPE OF ALL WORK BEING DONE__ /1 e~ ~...~~ Flo.,. ~r ~
~~~
VALUE (Including labor and materials) $ ~Q o o . O o r ~~
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) d ~~, /
o~~o~
Cty, •tpNio~A
Diviiien er 1o1puo11 Sa
3/f Cliwti MrMNr
IO aer 1130
p~rr~w1 s~wo3•>>~0
bsq. ab=~+-io:o
hx ~~o.ssraaw
c Insrtallati~on Verification
I' N ~.-,
~ (Fdectricel Contractor Namc7
~ {C3ty) (State) i~1p Codc)
(Addiws)
have'~een coatractod to pearfotrn electric irlstallatioa work for ('Jame of parry ~ traded w}
at the fiollowing address: ~0~3~ rn ~" V' ~ r K ° y
~Addreas where work will be performed}
The t[atura of the work cont;ia+s~ of: (Gbeck One or Describe the Name of ~~'ork j
Reoo~eetioa or new circuit for replacetnwt Heating Plant ud~'or ,~'C Condeaser.
Reconaectior. orn~ circuit for replace~men~*. Electric W a:e: Hcaz-x or power vented
wgttr luatcr.
Reconnection. of the Ser~ncc Entra[ice Cable. Meter Box, altxrations to recept,-cles
-~ as[d lighting fixturas due to aiding / soP6t installation. 1~'ote~ New Service
Eatta~ce Cables will regt:ite a aeparata pei~ncit.
Recoruaeet;ion or 31eW circuit for the raplacamerlt of other permanently wired
lea / tlact[ues.
Vew cit~o;tit fdr tl3e addition of AIC to an ted'ividtraf dwslltrtg unit (house or tte
individual systems in t- duplex ar condominium), including rcgttired service
e}~otrioal outlets,
C)ther I,
The value of tris wo~c is $ _~~ ° ~ °~
[ hereby verify this work will be performed by an anplayee of this campury and ftu'.her verify
k'aC rt~osssoction / installation will be done in compliance with rlanufacture~ aid Blect3lic code
rvgaire[aoats.
gnatur of Com~puny Officer) (Print Name of Ufficor) {Date)
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