HomeMy WebLinkAbout0095508-HVAC (a/c) ea CITY OF OSHKOSH No 95508
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 20 ROLLING GREEN CIR Owner MICHAEL R CISKE Create Date 06/27/2002
Contractor MARX MECHANICAL LLC Category 501 - Residential -Air Conditioning Plan
Fuel Gas 1 00 I 111 Electric Solar 1 Solid
System 0 New Re lace
❑ p 1 ❑ Other I
Li Forced Air u Radiant Li Steam IJ A/C Li Vent
Electric Hot Water Suppl. 1 1 Con. Bumer
Chimney Type r) Chimney A O Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved 0 Existing • Not Applicable Value 0
BTU Rate J As Per Plan O Variable • Other Value
Use /Nature SFR/ Install 2 ton central a /c. *EIV form from Beez Electric.
of Work
Fees: Valuation $1300.00 Plan Approval $0.00 Permit Fee Paid $24.50
Issued By: k Date 06/27/2002
❑ Permit Voided
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 4535 STATE ROAD 91 OSHKOSH WI 54904 -6304 Telephone Number (920) 235 -6510
ay. sa
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050
Fax (920) 236 -5084 Of HKOJH
ON THE WATER
HVAC PERMIT APPLICATION
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 $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participatingin the Permit fee Account System and have adequate funds, check here
if you want this processed through your account n
DATE (10 —p( , U
JOB ADDRESS OW I OLL/n16
OWNER hi I ICE 0-1 SSE
CONTRACTOR N .._ -} I e
CHECK H ALL APPLICABLE
USE CATEGORY
Single Family ❑Duplex ❑Multi Family ❑Rental / ❑Commercial ❑Iudustriai
FUEL ❑Gas I Electric ❑Solid SYSTEM New ❑Replace
❑Oil ❑Solar ❑Other
TYPE
❑Forced Air ❑Radiant ❑Steam I A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED VSINo ❑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 ❑Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable ❑Other Value
DESCRIPTION OF ALL WORK BEING DONE /+'ISTAt,L
LEJnlox HSZq -a
/IA w
VALUE (Including labor and all materials including light fixtures) $ (300
ELECTRICAL CONTRACTOR
OR ❑ Electric Installation Verification form attached(If Replacement)
Electrical installation ofnew /replacement equipment shall be done by licensed contractors.
3/02