HomeMy WebLinkAbout0134220-HVAC (furnace)CITY OF OSHKOSH
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 825 WINNEBAGO AVE Owner BETTY J LOSSE
No 134220
Create Date 12/01/2008
Contractor CUSTOM HEATING 8~ COOLING Category 500 -Residential-Heating & Ventilating Plan
Fuei / Gas Oil Electric ~ Solar Solid
System ~ New ~ / Replace _ _ ~ Other
/ 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 80,000
UselNature FR /REPLACE FUNRACE, EIV SIGNED BY HOEHNE ELECTRIC "check #9814
of Work
Fees: Valuation $3,000.00 Plan Approval $_0__.0__0 Permit Fee Paid
Issued By: ~~~-
Permit Voided
$55.00
Date 12/01/2008
Parcel Id # 0202780000
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 applignt 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 pertormed within two business days from the time the project is ready.
City of Oshkosh R E C E I V E
Division of Inspection Services
P.o. sox I13o DECO 1 2008
Oshkosh, WI 54903-1130 ,
Phone (920) 236-SOSO DEPARTMENT OF
Fax (920) 236=5084 .COMMUNITY DEVELOPMENT H f~
.•••. INSPECTION SERVICES DIVISION o+~ r:,c WATFR
_ HVAC PERMIT APPLICATION
All information aRer bold categories must be provided.
Incomplete applications will not be processed.
• Application(s) and feels} can be brought to City Hall, Raom 205 or mailed to Inspection Services, PO Box 1128.
Oshkosh WI 54903-t 128. Commencing work without permit{s}will result in fees being doubled or $100 00 pl~.:s ,h,
normal permit fee, which ever is greater. '
OR _
** Advisory -For applicable projects, an Electrical Installation Verification (ETV} form, signed by the Electrical
Contractor or Homeowner {for installations allowed to lie performed by the homeowner} must be submitted
with the permit application. Applications submitted without an ETV when such is require ,will not e
processed for Permit Issuance and will be returned for completion.
DATE
_ _ _ ., i
JOB ADDRESS
OWNE
CONTRACTO
CHECK LJ ALL APPLICABLE
USE CATEGORY
.Single Family ^Dyplex QMulti-Family
FUEL was ^Electric ^Solid
^Oil ^Solar
^Rental ^Commercial
SYSTEM ^New
^Other
C7lndustrial
pace
`TAPE
OrCCd Air DRadia;~t ^Steam DA/C OVent ^Electric OHot Water CJSuppl.
IS CHIMNEY $EING LINED C3No~les -LINER SIZE & MANUFACTURER
*iota All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ^Chimney A ^Chimney B. ODirect Vent ^Other
HEAT LOSS ^As Approved `existing ^Not Applicable ,
BTU RATE ^As Pet Plan ^Variable OOther Value L
JCon. Burner
d~
DESCRIPTIO / SCOPE OF ALL WO BEING DONE ~~~ ~~~
VALUE (Including labor and materials) $ ~~~~
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
City of Oshkosh
Division of Iospection Services
21S Church Avrnue
PO13oz 1130
Oshkosh WI 54903-1130
H H office 920-236-5050
ON THE WATER Fu 920-236-5084
I (We)
Electric Installation Verification
(Electrical Contractor Name)
~~-. ~~~ ~~-K--~ ,~~~-ems ~ ~~',~-3
(Address) ~ (City) (State) (Zi
have been contracted to perform electric installation work for ~~
(Name of party contracted to)
at the following address:
~~
(Address where work will be
The nature of 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 (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $ ~`'~ ~
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection /installation will be done in compliance with manufacturer and Electric code
requirements.
~ ~ 1
i ature o ompany Officer) (Print Name of Officer) (Dat