HomeMy WebLinkAbout0142754-HVAC (a/c) l CITY OF OSHKOSH No 142754
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 325 WINDINGBROOK DR Owner ROBERT T /KAREN M DAHLGREN Create Date 08/24/2010
Contractor DRUCKS PLUMBING & HEATING CO IN( Category 501 - Residential -Air Conditioning Plan
Fuel U Gas Oil U Electric Solar Solid
System ❑ New ❑ Replace 1 ❑ Other
L Forced Air ❑ Radiant Li Steam H A/C J Vent
Electric Hot Water U Suppl. [J Con. Burner
Chimney Type J Chimney A 0 Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved 0 Existing • Not Applicable Value
BTU Rate () As Per Plan () Variable 0 Other Value
Use /Nature SFR / Replace a /c. EIV signed by Drucks Electric.
of Work
Fees: Valuation $2,300.00 Plan Approval $0.00 Permit Fee Paid $44.50
Issued By: kif." ..- Date 08/24/2010
❑ Permit Voided Parcel Id # 0614400700
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 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 (Le. 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.
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City of Oshkosh
Division of Inspection Services
P.O. Box 1130 • •
Oshkosh, WI 54903 - 1130'
Phone (920) 236 -5050
Fax (920)236-5084 OJ HKOf 1--1
ON THE WATER
HVAC PERMIT APPLICATION
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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 •
f yQu area contractor participattnz in the Permit fee Account System and have adequate funds, check here
i you want.this processed through your account ri
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** 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. Applicatioris. without an EIV when such is required, will not be
processed for. Permit Issuance and will be returned for completion.
• DATE $ i 3 r o
JOB ADDRESS 32 Q K. •
OWNER ' ' Qn .
S -L A 4 )
CONTRACTOR S ( rS r- V. . • •
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CHECK ALL APPLICABLE.
USE CATEGORY
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Single Family . DDuplex ❑Multi- Family ORental OCommercial • DIndustrial •
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FUEL OGas g9,Electric :GJSolid SYSTEM ONew OReplace •
OOil OSolar DOther
TYPE •
DForced Air ORadiant OSteam Pia OVent :Electric OHot Water OSuppl. OCon, Burner • . •
IS CHIMNEY BEING LINERNalo ❑Yes, - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
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CHIMNEY TYPE OChimney A OChimney B DDirect Vent DOther
HEAT LOSS . DAs Approved DExisting ONot Applicable
BTU RATE DAs Per Plan OVariable DOther Value • •
DESCRIPTION / SCOPE OF ALL WO AK BEING DONE . •
c 'E�OC(. 4(G . -
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VALUE (Including labor and materials) $ 2.300 L i • •
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ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) .
07/07
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City of Oshkosh
Division of Inspection Services
215 Church Avenue
PO Box 1130
^ /
Oshkosh 4902•1130
Office ce 9 920.0. 236.5050
ON THE WATER • Fax 920 -236 -5084 •
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Electric Installation Verification •
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(1) (We) O 2ict! 4 S Zo'7L/G
(Electrical Contractor. Name)
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• (Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for 4IItLS
(Name of party contracted to)
at the following address: ZS L s% "+bi • N 6 B b1c 4:6141COSA, t*.
(Address where work will be performed)
The nature of the work consists of : (Check One or Describe the Nature .of Work)
i Reconnection or replacement Heeting411Fremlieir 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 $ od •
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. •
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Ale; :.�� W — _
(Signature of ompany Officer) (Print Name of Officer) (Date)