HomeMy WebLinkAbout0139883-HVAC (furnace)0
OSHKOSH
ON TH E WATER
,fob Address 1417 N MAI T
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Contractor
DRUCKS PLUMBING HEATING C0 IN Category 500 - Reside I- He at ng & Ventilating Plan
Fue
bars
OiI � lectri po _..
SoIid
S y stem
New
Re place ce Oth
Formal Air
F 1 stern W.
1
- glen
Lj lectric
- uppl. Con. Burner
Lj Hot Water
Chimney Type
Chimne A
hi ney B Direc Vent x. Not Applicable
Heat Loss
existing �._ �....�. Not Applicable ...... Value
r As Ap roared
BTU Rate
A s Per Plan
Variabl Other � Value
Use /Nature
of work
FR 1 Replace furnace. EIV signed by
Owner EDNA M KELLE
Liectric.
No 139883
Create Date 021261201
Fees: Valuation $4 Plan Approval $0.00 Permit Fee Paid
Issued By:
F] Permit Voided
$76.00
Date 02/26/2010
Parcel td # 1600790000
In the performance of this work, I agree to perform all work pursuant t rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Dato
Agent/Owner
Address P O BOAC 366
ME ASHA WI 54962 -355 Telephone Number 920 - 426 -2654
To schedule Inspections please call the Inspection Request line at 236-5128 acting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we w ill assume the p ro j ect is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
D ivisi-on of Inspection Services
P.O. Box 1130 .•
Oshkosh, W1 54903 - 1130 '
Phone (920) 236 -5050
fax (920) 2365084 QIHKIOf 11,
ON' THE WATF
HV AC PE RMIT APPLICATION
All information after bold categories must be provided. '
incomplete applications will not be processed.
Application(s) and e s can be brought to City Hall, Room 205 0' r railed to Insp eetion Services, PO Box 1128,
Oshkosh W1 54903 -1 128. Commo cing work without permit(s) wi result in feo s being doubled or $100,00 plus the
normal p nnit fqe, which ever is greater..
OR
our are - q contractor part Icf tin ire th P erinit Lee Ac ciount SY stent and have ado uale Lunds. check sere
1[ you )vitnrthis r sed (hroygh your accom
. vi Advis o =-For applicable projects, an Electrical Install lon Verification (EIV) form, signe d by the Ele e ri al
C o or Home owner (for' install a ions allow a d to b a p erforme d by t . o o nor ) riust be submitte
with the permit applic at n. App li"catiotis. s itte d Nvit o t an EIV when S c s re quired, wiU not e
p rocessed for Permit Issuance and will be retumed for completion. i
DA' '~
JOB ADDRESS I�� ,L_���ii S�t
OWNER �Wll1 !
CONTRACTOR D l - et 6 t!:�_ �t ; + � � r �
CHECK 0 ALL APPLICABLE.
USE CATEGORY
+ 'l � C � l � a� EIR r tal �Commercia ' El a s ial i
ingl Fame
FUEL a E]Electrio 0,Soli F SYSTEM ONow FReplace
n o o i l DSo la 0 t1ier
`Y'
IpFo rced Air DRa la t 0S team DA /C O Vent DElectric 1JH t Water 11 Su 1.
IS CHIMNEY BEING LINED lobo DY s, : LINER SIZE & MANUFACTUR
Note: All chimneys shall be sized per the BT'U's being �ented,
CHIMNEY TYPE 0 A qaChimney B ODir et Vent 00ther
HE AT LOSS. q4s Approved O Existing ONot. Applicable
B TU RATE PTAs Per Plan O ariable C1 then Value
DESCRIPTION ION SCOFF OF ALL WORK BEING D ONE IVA eief
y
•
VALUE (I ncludIng labor and materials
BLE'C TRICAL CONTRACT (for projects not requiring fi rs EIV Form)
bCon. Burner
7 /0*7
11
City of Oshkosh
Division of lm�er, 60n Services
215 Church Avenue
PO Box 1 130
Oshkosh wi 54902-113
a/WOf Office 920-2 36-5050
ON THE WRIER Fax 920. 236 -5084
El Verification
( ff
(Electrical C 6tractor Name)
( Add ress) (Ci (State) (Z Code
have been c to perform electric installation work for AL �le
(Name of party coytiacted to
at the following address.
(Address where work will be performed)
The nature of the work consists of : (Check One or Describe the Nature.of Work)
Reconnection o-n 'for replacement Heating Plant a e&wex
Reconnection or new circuit for replacement Electric Water Heater.
Reconnection of the Service Entrance Cable, Deter 96x, alterations* to receptacles and
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 applian fixtures.
Other
y
The value of this work i
I hereby veri fy this work w iII be performed b y a n employee of this company and further veri fy the
reconnection installation will e done in compliance with {man ae u er and Electric code
requirements.
11fA 2-- 1�5 -to
}
(Signature of Comps y d fficer) (Print lame of Officer) (Dat