HomeMy WebLinkAbout0091904-HVAC (furnace) C i) CITY OF OSHKOSH No 91904
OSHKOSH HVAC PERMIT APPLICATION AND RECORD
ON THE WATER
Job Address 2003 WINCHESTER AVE Owner DAVID R ROTHE Create Date 12/18/2001
Contractor TENTH STREET STATION INC Category 500 Residential Heating Ventilating Plan
Fuel 11 Gas I Oil I I Electric 1 1 Solar Solid
System New 1 n Replace Other
U Forced Air Radiant u Steam u A/C J Vent
Electric I Hot Water 1 Suppl. I Con. Burner
Chimney Type Chimney A Chimney B 0 Direct Vent 0 Not Applicable
Heat Loss As Approved Existing 0 Not Applicable Value
BTU Rate As Per Plan O Variable O Other Value 75M btu
Use /Nature SFR/ Replace furnace. *EIV form from Drexler Electric attached.
of Work
Fees: Valuation $2,300.00 Plan Approval $0.00 Permit Fee Paid $39.50
Issued By: KrA Date 12/19/2001
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 924 OHIO STREET OSHKOSH WI 54902 -0 Telephone Number 236 -8770, MOBILE 7
1211712001 23 9202360150 TENTHSTREETSTATION PAGE 01
ravision of InspacEion Eervices
4) 21.S Church Awellue
P.O. Box 1120
C) ft Oshkosh. wl S4S03
0,11vi 2A--SO4
Phone IP;o) 2:14-59iO
EVAC RFRMIT APPLICATION
fie1ds/inftrmation after bolt categories must be provit.(:t.
Incomplete applioations will not be processed.
DATE ilaf
(Ica ADDRESS -c$03 V frt fACCF-C4
CWNZIT
1
COYFR:PcCTOft Teliocksirra -54.41191- ittte
rrTzri.z ALLAR.RLickaLs._.
USZ CATEGORX DUPLEX
MULTI-7AMILY COMMERCIAL
FUZI. g3) OIL SOLAR SOLID
SYSTEll NW PIAC OTHER
TYPE etnen AT!;( aADIANT A/C VENT
ELECTRZO HOT WATER SUPPL. CON Ei
IS CHIMNEY BEING LINED AM LINER ELIE MANUr
Note; A11 chimneys s: ne sized per the BTU's Ecim9 vented.eyir406, 4..-k4Jpser
marmiwy 7HTMNLY A 4111102M10 nTRE'er
:MAT AS Al-IPROVED 4411111111111b NOT kICf 2..
3T1 RATE AS Pi PLAN ItARTAILEL OTJi VALUE
IATURE OF WORK: 4'14At 404244 411131 2-4'4r€5e.
elea fiv4,
(rhciuding 1cr ancl ma:erials) 5
_1 4ef-4
2=R OCWTIVICTOR hreofitt 6'7
:le trical installaticn7if r7e ec,iomcznt dor.e by licensec
:on:rectors.
520.00
•1)00.01 to $10,000.00 00 fpr f :E:
$1,000.00 plus $1.5t per 5100.00 valuaticb 9:
10_000.01 Co 52.5,00C fOr
;1U,U00.06 plus SI ub pt-r t;10j00 v31UL4LiOn Or paz:
ver 525,000 00
saos.co
pttr F valltaL,uion or pal'l u!
Submit paymen: witn abplibaticn. Failure :o pay wi:h.in
fees being doublt:JA S100 OU pv):111i..L tve:-
greater_
12/17!2001 23:03 9202360150 TENTHSTREETSTATION PAGE 02
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Electric Istatithation Verification
m(we) rte wc.Ttztc
(Eleciricel Connector Nome)
_Tip �7 Rat FF Pi uct:
(Address) (City)
(State) (Zip Code)
Iwo been contracted to perform electric installation work for 1 sirli $'7'_4117- -57"."")
(NentiroPparty contracted to)
at the following address; A Ca4
l Get yr en_
(Adrtreerwhere work will be perfortnad)
The nature of the work conain (Cheek One or Describe Nature of Work)
replacement Hosting Plant and /or AJC Condenser.
Reconnection or new circuit
R-Service-ber replacement Electric Water Heater. E C te, Meter Box, alterations to receptacles and
lighting fixtures due to siding! soffit installation. Now New Service Entrance
Cableantitt rWseparetr-pennit.
Reconnection or new circuit for other permanently wired appliances fixtures.
Other_
The value of this work isT G�
I hereby verify this wart iiabaperfo+med by an employee of this company and further verify the
reconnection installation will be done in compliance with manufacturer and Electric code
requirements.
Aitt
n, an is 2Re it iErZ -I 0
(Signature o Company y Office (Print.Natne of Meer)
(Date)