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Home My WebLink About0098096-HVAC (furnace) 0 CITY OF OSHKOSH No 98096 OSHKOSH HVAC PERMIT APPLICATION AND RECORD ON THE WATER Job Address 1222 BOWEN ST Owner MICHAEL R BREFCZYNSKI Create Date 10/21/2002 Contractor AMERICAN HEATING A C CO Category 500 Residential- Heating Ventilating Plan Fuel l✓ Gas 1 I Oil 1 Electric U Solar 1 I Solid I System n New 1 M Replace Other u Forced Air J Radiant u Steam u A/C U Vent 1 Electric Hot Water 1 Suppl. Con. Bumer Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent O Not Applicable Heat Loss 0 As Approved Existing 0 Not Applicable Value 0 BTU Rate As Per Plan O Variable Other Value 75m Use /Nature SFR/ RENTAL/ Replace 75m btu forced air furnace. *EIV form from Seckar Electric. of Work Fees: Valuation $1,650.00 Plan Approval $0.00 Permit Fee Paid $30.50 Issued By: Date 10/21/2002 Permit Voided In the performance of this work, I agree to perform all work pursuant to rules goveming the described construction. Signature Date Agent/Owner Address 1129 MICHIGAN AVE OSHKOSH WI 54902 -6437 Telephone Number (920) 235 -8090 City of Oshkosh RE Division of Inspection Services P.O. Box 1130 Oshkosh, WI 54903- 1130 Phone (920) 236 -5050 OCT Fax (920) 236 -5084 2 1 aDiHKIIIH ,f3 Dep r, ON TH E WAT F R HVAC PERMIT APPLIC 'Iry -EN All information after bold categories must be provided. O E V Eta F Incomplete applications will not be processed. �ENT 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 $100.00 plus the normal permit fee, which ever is greater. OR If you are a contractor participating in the Permit fee Account System and have adequate funds. check here if you want this processed through your account (l DATE /0 /j JOB ADDRESS /22 Z !S A w ,4 OWNER g "C2,J$ /c r CONTRACTOR v CHECK El ALL APPLICABLE USE CATEGORY 1Single Family ❑Duplex ❑Multi Family Rental ❑Commercial ❑Industrial FUEL 'Gas ❑Electric ❑Solid SYSTEM ❑New tJaeplace ❑Oil ❑Solar ❑Other TYPE forced Air ❑Radiant ❑Steam ❑A /C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner IS CHIMNEY BEING LINED ❑Noes LINER SIZE V y MANUFACTURER FLex L Note: All chimneys shall be sized per the T U's being vented. CHIMNEY TYPE Chimney A ❑Chimney B ❑Direct Vent ❑Other HEAT LOSS DAs Approved Ixisting ❑Not Applicable BTU RATE DAs Per Plan ❑Variable 13Other Value iZTZ? DESIRIPTION OF ALL WORK BEING DONE pee /qc e- "fcTod 0 v r ©mac' e, %tiJ, z r' P VALUE (Including labor and all materials including light fixtures) /S ELECTRICAL CONTRACTOR OR Electric Installation Verification form attached(if Replacement) Elect ca installation ofnew /replacement equipment shall be done by licensed contractors. 3/02 q"1.) City of Oshkosh D'►v ston of Intpacnoa Scrims 215 Gayeh Avenue POBtuit3D 7 PI OahkeaR W154902.1130 �.J 0111/41 .204.36.5030 oft NI VMS$ Pax 920.236.30$4 Electric Installation Verification (l) (We) SECicike E creic coptPAM V, 1 Ne (EIectrical Contractor Name) sei Zv cognvey Pt vmere gD, t N de cow &i 5'iej8( (Address) (City) (State) (Zip Code) have been contracted to perform electric installation work for ,4 /hE(C A/ 1te4rpu( (Name of party contracted to) at the following address: /22 (Address where work will be performed) The nature of the work zonsists of (Check One or Describe the Nature of Work) x 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 recapticies and lighting fixtures due to siding sofa installation. Note! New Servic: Entrance Cables will require a separate permit. Reconnection or new circuit for other permanently wired applia ..;es fixtures. Other The value of tabiL work is /50.0 I hereby verify this work will be pert' jrmed by an employee of this company and further verify the recormection installation will b. done in compliance with manufacturer and Electric code reauirernents. _ft iJ 1e. ski (Sign+: cure f Company Officer) nt Name of Officer) (Date)