HomeMy WebLinkAbout0100207-HVAC (furnace)(~ CITY OF OSHKOSH
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 836 W 12TH AVE Owner ALLAN R/RENAE N KOCH
Contractor RASMUSSEN'S HEATING & A/C INC 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 IO Chimney A ~ Chimney B ~ Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable O Other I Value 80m btu
No
Create Date
Plan
~J Solid
Vent
100207
03/14/2003
Use/Nature RENTAL/Replacement of furnace. *EIV form from Slim's Electric.
of Work
Fees: Valuation
Issued By:
$3,230.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$54.50
Date 03/14/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number
920-235-6569
City of Oshkosh
Division of Inspection .~n~ces
P.O. Box 1130
Oshkosh, v~ ~34
P~ (~2~ ~5o5o
OZH,
ON THE WATER
HVAC PERMIT APPLICATION
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 1128,
Oshkosh WI 54903-1128. Commenoing w~k without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, wh/ch ever is greater.
OR
If you are. a. contractor participating in the Permit_fee ,4ccount System and have .adequate _funds, check here
if you want this processed through _your accot~nt ~'~ ...
Ci~.~ [] ALL APPLICABLE
USE CATEGORY
ElSingle Family ClDuplex
EIMulti-Family
~ental
VICommercial
I~'EL El'Gas ClBlectric rigolid SYSTEM
r'iOil I"lSolar
[3New [E~eplace
~E
[~orced Air l-lRadiant rlSteam ri?dC riVent rlElectric
I$ CBIMNEY BEING IJNED ClNo I~es - LINER SIZE
Note: All chimneys shall be sized per the BTLPs being vente&
CHIMNEY TYPE [~Chimney A ~Oaimney B
WI~.AT LOSS I-IAs Approved
BTU RATE EIAa Per Plan EIVariable
riHot Water riSuppl. EICOn. Burner
t
EIDire~t Vent clOther
E]Not Applicable
i 'O er Value
DESCRIPTION OF ALI, WORK BEING DONE [~e.}oJ.o.~.~=~,'-C ,aO
VALUE (Ineluding labor and all materials induding light frxtures) $ ~:~c~ ~ '.,? .:,:~ ~.,
~Li~-CrRICAL CONTRACTOR $[~ S ~/et, eec., . ':
gl/For applicable projeots, an Ele~trio Inslallation Veiifioation fo ,nn, ~igned by the F, le~tric~d Conlractor, must be
attache~ If not atiaohed or not applicable, a selnm~ Hlet~ical permit is ~
Electric Installation Verification
(Bleotrical Contractor Name)
(Address) (City) (State) (Zip'Code)
havo been contracted to perform_ electric installafien wofl~ for
at the following address: ~3~ ~0 1 ~ ~k
(~ wh,~-~ work -al t~ i~t'ormed)
The natm~ of the work consists o~ ( .Ch~k One or Descnl~, the Nature of Work)
Th~ value ofthis work is $, oQO~, c~