HomeMy WebLinkAbout2010-HVAC (boiler) 0 CITY OF OSHKOSH No 140567
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 508 REICHOW ST Owner RAYMOND L/SUSAN A ELLINGSEN Create Date 04/20/2010
Contractor GARTMAN MECHANICAL SERVICES Category 500 - Residential- Heating & Ventilating Plan
Fuel Ill Gas LJ Oil I Electric
I Solar 1 Solid
System EJ New Q Replace n Other
LJ Forced Air LJ Radiant LJ Steam LJ A/C LJ Vent
1 Electric I ✓1 Hot Water 1 Suppl. I 1 Con. Burner
Chimney Type 7 , r ) Chimney A ( ) Chimney B • Direct Vent 0 Not Applicable
Heat Loss () As Approved • Existing 0 Not Applicable 1 Value
BTU Rate MILELE. Variable Other
Value
Use /Nature SFR / Replace boiler. EIV signed by Slim's Electric. "debit acct
of Work
Fees: Valuation $6,880.00 Plan Approval $0.00 Permit Fee Paid $113.50
Issued By: �i ./2/ Date 04 /20/2010
El Permit Voided I Parcel Id # 0611000000
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. 1( 16
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130 ' "
Phone (920) 236 -5050
Pax (920) 236 -5064
0_ IHTVIH
HVAC PERMIT APPLICATION Oie THE WATER
All information after bold categories must be provided
Incomplete applications will not be processed.
• 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 permit(s) will result in fees being doubled or 5100.00 plus the
normal permit fee, which ever is greater.
OR
I o •. re a c.nrp• • c1or .ar . C1, , tin in eh 'er, it a ,cc, nt S stem a d h• e ode- .ue u ,s check here
I .0 -nt hi .r. e • t -o 2h
_ •uric, n I S
** Advisory - For applicable projects, an Electrical
Contractor or Homeowner (for � Installation Verification � form, signed by the Electrical
( 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 pezthitIssuance and will be returned for completion.
DATE /FAL
JOB ADDRESS SD e t 1., e ,
OWNER_____
CONTRALTO Vl In
Cauca a ALL APPLICABLE
USE CATEGORY
Cleingle Family ❑Duplex CIMulti Family °Rental C7 Commercial CDndustrial
FUEL E ❑Blectric ❑Solid SYSTEM ❑New
.1:10i] LSolar DOther C4REplace
TYPE
DForced Air ORadiant ❑Steam DA/C ❑Vent C]Elect is
LINED �t ware C7Supp1. ❑Con. Burner IS C V ys IEY BEING
l b sired r th e BTU s bcin vented,
SIZE
per & MANUFACTURER_
g ed,
CHIMNEY TYPE Chimney A . 17ChimAey 13 G� ect Vent DOther
. A X' LOSS , (7As Approved
ble l7Not Applicable
$Ti7 RATE DAB Per ply d. V im. ., .'
�er Value ic,g, oG o /3 71j
DESCRIPTION / SCOPE OF ALL WORK BEING DONE r'_e /G Ce rw - 6 i 4
•
VALUE (Including labor and materials) S 0
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) ,/,,,,
07/07
Received Time Apr. 20. 2010 7:56AM No. 0633
Apr. 20. 2010 7:57AM GMS INC No. 0306 P. 2
City of 0.16;c4
I>irr�on *limped= Services
21s [MReh A.var
OOHox 1130
estikooh WI 54903-1130
Oh: ; (417/: Cm* "°"2369030
Fax 120.236:309.
Electric installation Verification
I(We) SLIM'S ELECTRIC .INC.
• ntractor
(Electrical CoName)
•
2608 Oakwood Circle 'Oshkosh WI 54904
(Address) (City) • • • (State) (Zip Code)
have been contracted to perform electric installation work for •
• (Name o patty contracted ) •
at the following• address: _ GJ�-� • Q. �'.� .: •
(Address where work Will be performed)
The nature of the work consists of: (Cheek One or Describe the Nature of Work)
Reconnection ur new circuit for replacement Heating Plant and/or A/C Condenser,
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater. '
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
:and leg g fixttucs due to siding /.saint installation. Note: New Service
• Entrance Cables will mire a s permit.
Reconnection or 0e9,e for thereplacement of other.pemnanently wired
appliances ) fixtures: • • • •
New circuit far the addition of.A/C to an individual dwelling unit (house or the
individual systems m a duplex .or condominium), including required service
electrical outlets,
Other .
•
The value adds work is $ \I ,
I hereby .verify.tliis.work willbe performed 'by an employee of this company and farther verify
the recoanecxian / installation Will be 'done in compliance With manufacturer read Electric code
reciur,nents• ,
•
aol
(Signature of Com , J� ter) (Print Name of Offic (pste)
vaz
Received Time Apr. 20. 2010 7:56AM No. 0633