HomeMy WebLinkAbout0142043-HVAC (furnace & a/c) 0 CITY OF OSHKOSH No 142043
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 161 N LARK ST Owner ROYAL BOESE Create Date 0
Contractor DRUCKS PLUMBING & HEATING CO IN( Category 502 - Residential-Both Plan
Fuel Gas O11 Electric
ESolar ❑- Solid j
System ❑ New 0 Replace ❑ Other J
✓ Forced Air J Radiant J Q
Steam 1Er^' C Q Vent
Illie 1 ❑ Hot Water [❑ Suppl. ❑ Con. Burner
Chimney Type chimney A 0 Chimney B 0 Direct Vent • Not Applicable
0 —__ g_ - _ Not Applicable Loss As Approved Existing �- pp licable Value
BTU Rate As Per Plan 0Vanable 0 Other Value
Use /Nature SFR / REPLACE FURNACE & A/C, EIV SIGNED BY DRUCKS PLUMBING & HEATING * *check #63543
of Work ,
Fees: Valuation $6,870.00 Plan Approval $0.00 Permit Fee Paid $113.50
Issued By: Date 07/15/2010
❑ Permit Voided
- _- Parcel Id # 0609040000
In the performance of this work, I agree to perform all work pursuant to rules goveming 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 P 0 BOX 355 MENASHA WI 54952 - 355 Telephone Number 920 -426 -2654
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.
City of Oshkosh •
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130 •
Phone (920) 236 -5050
Fax (920) 236-5084 Of HK0/H
ON THE WATFR
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed,
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• 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 •
ff you area contractor particinatinz in the Permit fee Account System and have adequate funds, check here
if you want. this processed through your account f
** Advisory -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 will be returned for completion.
DATE - ?/0//0
JOB ADDRESS. /(,/ A f . 1.4 (-
Royal R
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OWNER �oeSe •
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CONTRACTOR b rix 2 IS
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CHECK 11 ALL APPLICABLE.
US ATEGORY
IfiiI5ingle Family ❑Duplex ❑Multi- Family DRental ❑Commercial ❑Industrial -
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FUEL Vas ❑Electric lO Solid SYSTEM ONew replace
❑Oil ❑Solar ❑Other
T • E •
orced Air DRadiant ❑Steam VA/C ❑Vent ❑Electric DHot Water ❑Suppl. ❑Con. Burner . •
IS CHIMNEY BEING LINED 64 ❑Yes, - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented. •
CHIMNEY TYPE OCjximney A ❑Chimney B [Direct Vent. 't Cher
HEAT LOSS s pproved OExisting ONot Applicable
BTU RATE VIA Per Plan ❑Variable ❑Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE . 6T V/fC Sys -fer i
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VALUE (Including labor and materials) $ l D b 7O 4 ' 16
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) •
07/07
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City of Oshkosh
411r �• Division of Inspection Services
215 Church Avenue
PO Box 1130
0.1 Oshc WI 54902 -1130
r'�,KO „ , j/ h Office 920-236-5050
ON THE WATER " Fax 920- 236 -5084
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Electric Installation Verification
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(I) (We) 1JY_UGi ( 5
(Electrical Contractor. Name) .
3) L i 479 54. /1464&& t v l c‘/•
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(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for /C, 0 c/a/ / Oes
/69 (Name of party contracted 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)
V 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
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The value of this work is $ 2 ur.) ' •
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
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requirements. •
/ /
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4:45/4 e >Orr At-rll'LL- -7 76/(d
(Signature of Company Officer) (Print Name of Officer) (Date)
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