HomeMy WebLinkAbout2008-HVAC (boiler)/~'~ CITY OF OSHKOSH
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 416 N MAIN ST Owner GIOMBETTI JAMES A
No 133662
Create Date 10/22/2008
Contractor GARTMAN MECHANICAL SERVICES Category 510 -Ind. &Comm-Heating & Ventilating Plan
Fuel / Gas ^ Oil Electric Solar Solid
System ^ New ^/ Replace __~ ~ they
Forced Air Radiant / Steam A/C Vent
Electric ~, ^ Hot Water Suppl. Con. Bumer
Chimney Type Chimney A _ ~ Chimney B Direct Vent Not Applicable
Heat Loss As Approved Existing Not Applicable Value
BTU Rate As Per Plan ___ _ (~ Variable Other Value
Use/Nature eplace steam boiler, install new chimney liner/vent., EIV signed by Slim's ElecVic "check #39247
of Work
Fees: Valuatio~_~^ ~r1~3,900.00 Plan Approval $0.00 Permit Fee Paid $199.00
Issued By:
Date 10/23/2008
^ Permit Voided ~ Parcel Id # 0400800000
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 Ciry 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 2264 _ _ OSHKOSH WI 54903 -2264 Telephone Number (920} 231-5530
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.
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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.
`.J
• 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
I ou are a contractor artici atin in the Permit ee Account S stem and have ade uate unds check here
i ou want this rocessed throu h our 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 sabmitted without an E1V when such is required, will not be
processed for Permit Issuance and will be returned for completion.
DATE ~~' d~.a-~, ~~
CHECK ®ALL APPLICABLE
USE CATEGORY
^Single Family ^Duplex ^Multi-Family
FUEL Gas
^ it
TYPE
^Forced Air ^Radiant
^Electric ^Solid
^Solar
^Rental Commercial ^Industrial
SYSTEM ^New Replace
^Other / '~
~ Steam ^A/C ^Vent ^Electric ^Hot Water ^Suppl. ^Con. Burner
IS CHIMNEY BEING LINED ^No ^Yes -LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ^Chimney A ~himney B ^Direct Vent ^Other
HEAT LOSS ^As Approved ^Existing ^Not Applicable
BTU RATE ^As Per Plan ^Variable ^Other Value
ALL WORK
VALUE (Including labor and materials) $ I~~I.J~J° ~/
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
o~/o~
ChyofO~hka~h
Biwivo oi`la~pemion Servien
1f Choeeh Avg
POBox tl30
aetosn wi s~c4a3-»3o
oma 42a2365050
Fu 420.236508/
Electric Installation Verification
e(we) SLIM'S ELECTRIC ING.
(Electrical Contractor Name)
2608 Oakwood Circle Oshkosh WI 54904
(Address} (City} (State) (Zip Code}
/~~
have been coatracted to perform electric installation work for _ ~, ~ .1.~_~ ~W,
, \\ {Name ofparty contracted ta)
at the following address: ~ l ~D IV \ 1~
(Address where work will be performed)
The nattu~e of the work consists of: {Chock One or Describe the Nature of Work)
~, Reconnectioa or new circuit for replacement Heating Plant andlor A1C Condenser.
Reconnection or new circuit for replacement filectric Water l:ieater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Sox, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reeonnectioa or new circuit for the repiacanent of other perm~ttently wired
appliances I fixtures.
New circuit for the addition of A/C to an tndivfdual dwelling rout (lwuse or the
individual systems in a duplex or condominium), iachtdin$ roquiretl service
electrical outlets.
OlhCr
The value of this work is -1--~
I hereby verify this work wiii be performed by an ernployoe of this company aad further verify
the recormection 1 installation will be done in compliaace with manufacturer and Electric code
requirements.
1
~~d901~,~ t2~,y~,~vJY~~ I~_ ~C~
(Signature of Comp cer) (Print Name of Offs (Date)
sroz