HomeMy WebLinkAbout0140568-HVC (furnace & a/c) 0 CITY OF OSHKOSH No 140568
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2367 HAMILTON ST Owner DANIEL J POLISHINSKI Create Date 04/20/2010
Contractor GARTMAN MECHANICAL SERVICES Category 502 - Residential -Both Plan
Fuel I✓ Gas I Oil U Electric Solar U Solid
System n New 1 121 Replace
❑ Other
VI Forced Air u Radiant u Steam u NC u Vent
J Electric u Hot Water U Suppl. ❑ Con. Burner _
Chimney Type 10 Chimney A () Chimney B • Direct Vent 0 Not Applicable
Heat Loss D As Approved • Existing 0 Not Applicable Value
BTU Rate As As Per Plan 0 Variable • Other Value
Use /Nature SFR / Replace furnace and a /c. Install 3" chimney liner. EIV signed by Slim's Electric. * *debit acct
of Work
Fees: Valuation $6,220.00 Plan Approval $0.00 Permit Fee Paid $104.50
Issued By:/2/ Date 04/20/2010
❑ Permit Voided I Parcel Id # 1214270000
In the performance of this work, I agree to perform all work pursuant to 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
Date
Agent/Owner
Address PO BOX 2264 OSHKOSH WI 54903 -2264 Telephone Number (920) 231 -5530
To schedule inspections please call the Inspection Request line at 236 -5128 noting 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 will assume the project 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.
Apr. 20. 2010 7:57AM GMS INC No. 0306 P. 3 v`l � 0
City of Oshkosh
Division of Inspection Services
p.0. Box 1130
Oshkosh, WI 54903 - 1130
Phone (920) 236 -5050
Fax (920) 236 -5084
ER
HVAC PERMIT APPLICATION rxFWAT
All information after bold categories must be provided.
Incomplete applications will not beprocessed.
• 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 permits) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater
OR
ar- a rntr,ato• •ar• - ci , _tin - in ,eP rmi - e ,cc. it tem an, have ede•uate ! !s chec here
•u va r t • •r,ce
d - au', ,.r a. al r
" Adi•#sory - For applicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by the homeowner) must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and wiz] be returned for completion.
DATE / 4/0
JO$ADDRESS 3 c 1 - 4 ,
•' ;�sk L
CONTRACTOR 6-1 i
CHECK 0 ALL APPLICABLE
USE CATEGORY
Din gle Family °Duplex DMulti- Family ❑Rental dCommercial Dindustrial
FUEL 19Ms ❑Electric ❑Solid SYSTEM DNew
DOiJ IJSolar ��
DOthar
TYPE
L orcedAir •DRadiant ❑Steam 1:11<ft aVent OBlectric DHotWater ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED CINo C 8 - LINER SIZE 3" & MANUFACTURER /7
Notes All chimneys shall be sized per the BTU's being vented.
C$hINEY TYPE ❑Chimney A DChinnn B
UEAT..LOSS , OAs Approved tat/Sting • Not A p]ic DOther
•�� RATE . g ❑Not Applicable
DAs Per Plan ❑Variable tether Value_ 2- 7` .
DESCRIPTION / SCOPE OF ALL WORK BEING DONE R.4 e ca. ,,�, �. .�,,,� c t G 14/c_
VALUE (Including labor and materials) $ 6;.z p ' an
• ELECTRICAL CONTRACTOR (for projects not requiting an EIV Form) r ..`
07/07
Received Time Apr.20. 2010 7:56AM No. 0633
Apr. 20. 2010 7:57AM GMS INC No. 0306 P. 4
Ch o(Owto b
MI o E a
Po Ilea 100
Oshk el W1 W03-1130
ON: .1ryji •
Fon 920-214-5064
•
• Electric Installation Verification
I (We) SLIM'S ELECTRIC INC..
.(Electrical Contractor Name)
2608 Oakwood Circle Oshkosh . WI 54904
(Address) • . (City) • • • ( te) (Zip Code)
•
have been comraoted to perform electric installation work fo •
• • • • • (Name of patty contracted to)
at the following address: • • . • / 1 • IA *• _ •
. • : .(Address what work will be performed)
The nature of the work consists of (Check One •or Aesop the Nature of Work)
Recorn ion or new circuit for replaccm„snt Heating Plant and/or A/C Condenser,
Reoolmection or new circuit for replacement Electric Water Heater or power vented
water.heater. • . • . • • .
Reconnection of the.Scrvice Entrance Cable, Meter Box, alterations to receptacles
wad lighting fixtnr+es duo to aiding ( soffit installation. Note: New Service
• Entrance Cables will regairo a separate permit. •
Reconnection or new circuit far the replacement of other permanently wired
appliances 7 fxtures. ' .
New circuit for the addition of A/C to an•fndf t'dual dwelling unit (house or the •
indi systems in a duplex or eondomivium), including required service
electrical outlets:
Oa= • . .
•
•
The value of this work is $ r- UU 1 hereby verify this •work will bc.performed by an employee of this company and farther verify
the reconnection'! innsiallation will be done in compliance with manufacturer and Eleatic code
negaii+emeuta. .. � .. . .. .
V.41 )'' AO
•1
(Signature of Comp cer) (Print Name of O (Date)
sloe
Received Time Apr. 20. 2010 7:56AM No. 0633