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CITY OF OSHKOSH HEATING PERMIT X
APPLICATION AND RECORD
Date /02• as 77 Application N2 3 7 9 9
Owner
Address
Building Use rte_
Type of Fuel:
Gas Oil
Coal Electric
Other
Type of Heating System:
Forced Air (number) Hot Water (number)
Steam (number) Gravity (number)
Unit heater (number)
New heating system \4 Replacement of:
Conversion Burner
New Used
Calculated Heat Loss 73, LsG v6 774/
Size of Unit(s) o
Miscellaneous Work to Heating System
Heating Contractor
Address 0 o 1L
sue,
Valuation of Work /fi Fee c- S J
Electrical Contractor
The undersigned hereby applies for a permit to do the work herein described, according
to the plans and specifications herewith filed, and hereby agrees that such work will be
done in accordance with said description, plans and specifications, and in compliance with
ordinances of the City of Oshkosh and the state building code of Wisconsin.
(Signed) Owner
Address
CITY
OF (By) �Y> Agent
OSHKOSH
Address
Heating Inspector
Final Inspection