HomeMy WebLinkAbout0132732-HVAC (boiler) CITY OF OSHKOSH No 132732
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATE R
Job Address 18 W 15TH AVE Owner JAMES D SEIDL Create Date 09/08/2008
Contractor CUSTOM HEATING & COOLING Category 500 -Residential-Heating & Ventilating Plan
Fuel / Gas
__~ Oil Electric Solar
Q~
Solid
System ~ New ~ Q/ Replace ~ ~ Other
Forced Air Radiant Steam A/C Vent
Electric_~ / Hot Water Suppl. 0- Con. Sumer
Chimney Type ~ Chimney A Chimney B Direct Vent Not Applicable
Heat Loss ((~As Approved Existing Not Applipble ~ Value
BTU Rate As Per Plan
_____ Variable Other
Value
Use/Nature FR /REPLACE BOILER DUE TO FLOOD DAMAGE, EIV SIGNED BY HOEHNE ELECTRIC "'check #9727
of Work
Fees: Valuation $4;500.00 Plan Approval $0.00 Permit Fee Paid $77.50
----
Issued By: ~~Sy... Date 09/08/2008
Permit Voided
Parcel Id # 0304690000
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 1503 S MAIN ST
OSHKOSH WI 54902 -6911 Telephone Number (920) 235-7263
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 y~'~
Division of Inspection Services '~ E~ E I V E D ~ ~r
P.O. Box 1130
Oshkosh, WI 54903-1130 SEP 0 8 2008
Phone (920)236-5050 '
Fax (920) 236-5084 DEPARTMENT OF f HK~
'' "'~ COMMUNITY DEVELOPMENT ON THE WATFR
_ HVAC PERMI~~R~~N6~1''PIV1s1oN
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 1 128,
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
!f you are a contractor DarticiDatinQ in the Permit fee Account Svstem and have adequate funds, check here
ou want this processed {~l,rp~h your. account
** 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) must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed fox Permit Issuance and will be returned for completion.
DATE ~~~ (g
/~' /
JOB ADDRESS ~ U ~ `~
OWN
CONTRACTOR" C~LC
CHECK D ALL APPLICABLE
USE CATEGORY
,,Single Family ^Dyplex ^Multi-Family
FUEL ~as OElectric ^Solid
^Oil ^Solar
TYPE
^Forced Air ^Radiant ^Steam ^A/C ^Vent
IS CHIMNEY BEING LINED~Io ^Yes -LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE Chimney A ^Chimney B,
HEAT LOSS OAs Approved ^Existing
BTU RATE OAs Per Plan ^Variable
DESCRIPTION /SCOPE OF~~~~L WORK B
~ ~~ ~
ORental ^Commercial
SYSTEM
^New
OOther
^Industrial
~eplace
^Electric (~?ot Water ^Suppl
.~^-
VALUE (Including labor and materials)
^Con. Burner
& MANUFACTURER
^Direct Vent ^Other
^Not Applicable
^Other Value
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
City of Oshkosh R E C E 11/ E
Division of Inspection Services
215 Church Avenue SEP 0 8 2008
PO Box 1130
Oshkosh WI 54903-1130
HK H Office 920-236-5050 DEPARTMENT OF
ON THE WATER Fax 920-236-5084 COMMUNITY DEVELOPMENT
INSPECTION SERVICES DIVISION
Electric Installation Verification
I (We) /~ ~~"~~
(Electrical Contractor Name or Homeowner's Name)
~1~ ~7~~ ~U/1~'0~ ~,/1 ~h C,L/~ ~f 9~3
(Address) (City) (State) (Zip Code)
accept the responsibility to perform the electric work as stated below, at the following address:
I8 W 15~` ~,re.,
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection 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.
Reconnection or new circuit for the replacement of other permanently wired
appliances /fixtures.
New circuit for the addition of 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 Electrical
Contractor.
Other
es
The value of this work is $ ~5~
I hereby verify this work will be performed in compliance with the License requirements of
Section 11-22 of the Oshkosh Municipal code and further verify the reconnection /installation
will be done in compliance with manufacturer and Electric code requirements. / /
~S '~-C~
(Signature of Company Officer or Homeowner) (Print Name)
07/07