HomeMy WebLinkAbout0100022-HVAC (furnace)OSHKOSH
ON THE WATER
.lob Address 136 W 22ND AVE
Contractor
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
GARTMAN MECHANICAL SERVICES
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner MARGARET A MORTENSON
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
100022
03/03/2003
Other
Vent J
Use/Nature SFR/Replace furnace. *EIV form from Beez Electric.
of Work
Fees: Valuation
Issued By:
$1,785.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$32.00
Date 03/03/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address PO BOX2264 OSHKOSH WI 54903 -2264 Telephone Number
(920) 231-5530
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 w. ill not be processed.
Off KO/tq
ON THE WATER
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1 t28,
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 contracto.r participating in the Pe.rmi~.~fee Ac. count System a.nd have adeq~tate funds, check here
i.[ yoa want this processed through ;~our account ~
CH~CK 17r ALL APPLICABLE"" :~: .; ~; ~:: :v ,.; ~ ...; :,;.~ ;~ L, ~ ~.~.:r.~. ,., ~.:~..i ,i! ............ :
E CATEGORY
ingle Family FIDuplex FIMulti:Family . F1Rental ...... E!Commemial ...... [3Industrial
\
FUEL [~as E]Electric IZISolid SYSTEM ~:~I~ ~l'Replace
V1Oil [3Solar
orced Air nRadiant ElStea EIVent nElectric
IS CItIMNEY BEING LINED EINo EIYes - LINER SIZE
Nole: All chinmeys shall be sized per the BTU'a being vented.
FIHot Water EISuppl. ECon. Burner
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS
BTU RATE
[3Chimney A
I-lAs Approved
I-IAs Per Plan
[3Chimney B
VIExisting
nVariable
UIDirect Vent
nNot Applicable
nOther Value
nOther
vA~LUE (i'nclUd/.~ lab°r'i~d iffi'ifiaterials Including light fixtures) $ t ! ~~"~ '
/'
ELECTRICAL CONTRACTOR
[] 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.
9/02
02~27/280~ 88:23
9282317255
BEE7 ELECTRIC
PAGE
0i
Electric Installation Verification
(1) (We)
~21 W. 12th Oshkosh
54902
have been contracted to perform electric installation work for ,Gartm.an_M~h~c~l,
at the following address: 136 W. 2~2ndAy~nue.
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.
R~,onuection or new circuit for replacement Electric 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.
Rcc, onn~ction or new circuit for other permanentiy wired appliances / fixtures.
The value of this work is $~
I hereby verify this work will be performed by an employee of this company and further verify the
reconnecfion / installation win be done in compliance with manufaCtUrer and l~lectric code
requiremeots.
(Signature of Company Officer)