HomeMy WebLinkAbout0142027-HVAC (a/c) CITY OF OSHKOSH No 142027
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2495 PARKSIDE DR Owner JOSEPH M /KARIN M DERENNE Create Date 07/14/2010
Contractor BLACK -HAAK HEATING Category 501 - Residential -Air Conditioning Plan
Fuel Li Gas Oil tric ✓ Electric z Elec 0 Solar J L] Solid
System New Q Replace [j Other
Forced Air ] 0-Radiant 0 Steam p✓ A/C 0 Vent
Electric ErHot Water jSuppl. o Con. Bumer
Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved • Existing 0 Not Applicable Value
BTU Rate As Per Plan - O Variable 111r6ther Value
Use /Nature SFR / REPLACE NC, EIV SIGNED BY DIERSEN ELECTRIC **check #22833
of Work
Fees: Valuation $2,000.00 Plan Approval $0.00 Permit Fee Paid $40.00
Issued By: Date 07/14/2010
Permit Voided Parcel Id # 1227120000
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 7075 APPLETON WI 54912 - 7075 Telephone Number 920 - 757 -9990
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.
Cieyof
�Svlslon oflnspectinnServicts
P.O. Box U30
( :;; - 11 - 1:027: )
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050 O�n \O�(�l
Fax (920)236 -5084
ON THE WATER
permi+ R.e HO. OD HVAC PERMIT APPLICATION
A ll 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 $100.00 plus the
normal permit fee, which ever is greater.
oR
If you are a contractor participatinz in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account fl
DATE �► I �, I I D
JOB ADDRESS Mg 5 Pad de Dr. ) Oshkosh
OWNER 1 and Varin De,'enne
CONTRACTOR blar aaK}l \11 •
CHECK El ALL APPLICABLE
USE CATEGORY
1,1 Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
FUEL ❑GaslElectric ❑Solid SYSTEM ❑New Replace
❑Oil ❑Solar ❑Other
TYPE
❑Forced Air ❑Radiant ❑Steam 'A/C ❑Vent ❑Electric ❑Hot Water DSuppl. ❑Con. Burner
IS CHIMNEY BEING LINED DNo ❑Yes - LINER SIZE — & MANUFACTURER —
Note: All chimneys shall be sized per the BTU's being vented.
•
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS DAs Approved (S Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable tOther Value -
DESCRIPTION OF ALL WORK BEING DONE 1 ns1 our rn Haiti o n.e r
VALUE (Including labor and all materials including light fixtures) $ good 0 LD
ELECTRICAL CONTRACTOR D IP,r Wl g ettriC LLC
❑ For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
Seth Diersen (920)582 -0806 p.1
Y 2 1 3 of011o A
Diriaee of hltpiedon 5crvitst
21 f ClwrcM •eme
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Electric Installation Verification
•
(1)(We) pIPX, r1 :far:ri t1C •
(Electrical Contractor Name)
igc304 O fef -1 l I vitnnecunn e WI 5 - 9 6 MP ,
(Address) (City) (State) (Zap Code)
have been contracted to perform electric installation work for BIi1tV WOLk peal In •
(Name of party contrac tb)
at the following address: 1_425_ _p irkstflt Q .$h •Sh 54 - D168
(Address where work will be performed)
The nsrure of the work consists of : (Cheek One or Describe the Nature of Work) •
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater.
Reconnection of the Service Entrance Cable, Meter Box, 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 appliances / fixtures.
Other
The value of this work is $ _
i hereby verify this work will be performed by an employee of this company and further verify the
reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
..?Z>Z:,•0 5:{ 44k a-e 6. 2
(Signature of i mpany Officer) (Print Name of Officer) (Date)
66 39vd L666LSLBL6 LZ 66 8'f0Z /EI/LB