HomeMy WebLinkAbout0100153 H(~ CITY OF OSHKOSH
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 155 N MEADOW ST Owner WILLIS E BUETTNER LIFE ESTATE
Contractor STEINBRUNER HEATING & COOLING Category 500 - Residential-Heating & Ventilating
Fuel ~J Gas J ~J Oil b~ Electric ~J Solar
System ~J New ~ ~J Replace ~ ~J Other
~J Forced Air I ~J Radiant L~ Steam ~J A/C
~J Electric I ~J Hot Water b~ suppl. ~J Con. Burner
Chimney Type I~ Chimney A ~ Chimney B O Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 60,000 btu
No
Create Date
Plan
~J Solid
Vent
100153
03/11/2003
Use/Nature
of Work
/ Replace furnace* EIV from Seckar Electric attached.
Fees: Valuation
Issued By:
$2,000.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$35.00
Date 03/11/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 600 OREGON STREET OSHKOSH WI 54902 -0
Telephone Number
(920) 426-1830
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.
O/HKO/H
ON THE WATER
Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1 ! 28. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
~f you want this processed through your account [~
I ·
SOB oo ss !55-
owNEi b ,tl,o
CONTRACTOR ~'~--
DATE 3- tl -0 "~
CHECK [] ALL APPLICABLE
ingATEGORY
le Family V1Duplex F'lMulti-Family UIRental
VICommercial
Vllndustrial
FUEL ill]Gas VIElectric F1Solid SYSTEM V1New
EIOil VISolar mOther
[~eplace
ed Air VIRadiant UlSteam F1A/C inVent F1Electric F1Hot Water V1Suppl. VICon. Burner
IS CHIMNEY BEING LINED ~o V1Yes - LINER SIZE & MANUFACTURER
Note: Ail chimney~ shall be sized per the BTU's being vented.
CHIMNEY TYPE VIChimney A VIChimney B EY~rect Vent mOther
ItEAT LOSS mAs Approved E3'E~sting F1Not Applicable
BTU RATE I-lAs Per Plan V1Variable mOther Value ~O:tg-o-o
DESCRIPTION OF ALL WORK BEING DONE A.~&~_ ~.~r-ta ~t~__
VALUE (Including labor and all materials including light fixtures) $ oQO0n9 o~
ELECTRICAL CONTRACTOR ~_x;~"' t r~ OR ~Eiectric Installation Verification form attached(If Replacement)
Electrical installation of new~replacement equipment shall be done by licensed contractors.
3/02
OJ'HK,OJ'H
Ci.ty of Oshkosh
Division of Inspection Se~,Sces
215 Church Avenue
PO Box 1130
Oshkosh WI 54902-1130
Office 920-236-5050
Fax 920-236-5084
Electric Installation Verification
(0 (We)
(Address)
(Electrical Contractor Name)
(City)
have been contracted to perform electric installation work for
(State) (Zip Code)
(Name of party contracted to)
at the following address:
(Address where work will be performed)
(Check One or Describe the Nature of Wo£$:)
,~ Reconnection or new circuit for.replacement Heating Plant and/or A/C Condenser.
Reconnection 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 pemait.
Reconnection or new circuit for other permanently wired appliances / fixtures.
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.
(Signatm'e o~ Company Officer)
(Print Narne of Officer)
(Date)