HomeMy WebLinkAbout0095876-HVAC (furnace) 0 CITY OF OSHKOSH N 95876
OSHKOSH HVAC PERMIT APPLICATION AND RECORD
ON THE WATER
Job Address 1609 WILSON AVE Owner SARJON T /DWNYA DAWOOD Create Date 07/16/2002
Contractor DRUCK'S PLBG HTG CLG Category 500 Residential- Heating Ventilating Plan
Fuel 111 Gas I I Oil I I Electric 1 Solar 1 Solid
System n New 1 0 Replace 1 n Other
U Forced Air u Radiant J Steam u NC LJ Vent
1 Electric 1 Hot Water I U Suppl. Con. Burner
Chimney Type 7 Chimney A Chimney B 0 Direct Vent 0 Not Applicable 1
Heat Loss C As Approved Existing 0) Not Applicable 1 Value 0
BTU Rate j As Per Plan Variable Other Value 45m
Use /Nature SFR/ Replace fumace. *EIV form from Solar Electric.
of Work
Fees: Valuation $1,450.00 Plan Approval $0.00 Permit Fee Paid $27.50
Issued By: )0^A Date 07/16/2002
Permit Voided
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 504 3RD ST P 0 BOX 355 MENASHA WI 54952 -0 Telephone Number (920) 426 -2654
Division of Inspection Services
4, 215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903 -1130
N w wn Fax (920) 236 -5084
Phone (920) 236 -5048
HVAC PERMIT APPLICATION
All fields /information after bold categories must be provided.
Incomplete applications will not be processed.
DATE G -lT Z
JOB ADDRESS /h', 4
OWNER 541%4 M.1A94 0 2
•1
CONTRACTOR 645 4G/ A
3tit 3
CIRCLE ALL APPLICABLE
USE CATEGORY SINGLE FAMILY DUPLEX MULTI- FAMILY COMMERCIAL INDUSTRIAL
FUEL AS OIL ELECTRIC SOLAR SOLID
SYSTEM NEW REPLACE OTHER
TYPE FORCED AIR RADIANT STEAM A/C VENT
ELECTRIC HOT WATER SUPPL. CON. BURNER
IS CHIMNEY BEING LINED LINER SIZE MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE CHIMNEY A IMNEY 3) DIRECT VENT OTHER
HEAT LOSS AS APPROVED QUIP NOT APPLICABLE
BTU RATE AS PER PLAN VARIABLE OTHER VALUE Ys
NATURE OF WORK:
VALUE (Including labor and materials) $/7529,e0
ELECTRICAL CONTRACTOR S®2,40 erLL'ir��IG
Electrical installation of new /replacement equipment shall be done by licensed
contractors.
Valuation Fees
0 to $1,000.00 2 0. 0 0
$1,000.01 to $10,000 00..-.-....-.-._._.- for first
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10,000.01 to $25,000.00. $155.00 for first
$10,000.00 plus $1.00 per $100.00 valuation or part thereof
Over $25,000.00 plus $0.50
per $100.00 valuation or part thereof
Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.
06/17/02 11:43 FAX 920 236 7725 Solar Electric 0141
City ofO h
414011, Division ofhapecuon Services
215 Chi h Avenue
PO Sox t 130
Oshkosh WS 54902.1 134
Office 920. 236 -5050
On THE ~ER Fax 020- 296-5064
Electric Installation Verification
(n (We)
(Electrical Contractor Name)
e(q, hoc s Pc/ Ahke zo t S XP
(Address) (City) (State) (Zip Code)
II
have been contracted to perform electric installation work for At cL
(Name of party contracted to)
at the following address: �j r s 24
(Address where work will be performed)
The nature of the work consists of (Check One or Describe the Nature of Work)
C. 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
lighting fixtures due to siding soffit installation. Note: New Service Entrance
Cables will require a separate permit.
Reconnection or new circuit for other permanently wired appliances f fixtures.
Other
The value of this work is j I
7 hereby verify this work will be performed by an employee of this company and further verify the f
reconnection installation will be done in compliance with manufacturer and Electric code
requirements. t
(Signa of Company Officer) t e of Officer) (Date)