HomeMy WebLinkAbout0084669-HVAC (9 CITY OF OSHKOSH N 84669
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 416 ROCK PL Owner GAY L MANDEIK Create Date 03/14/2001
Contractor CHRISTENSEN HEATING & A/C INC Category 500 - Residential- Heating & Ventilating Plan
Fuel Gas 011 Electric Solar I Solid
System O New Replace ✓ Other
✓J Forced Air Radiant Steam I A/C 1 Vent
Electric Hot Water Suppl. Con. Burner
Chimney Type ( ) Chimney A () Chimney B O Direct Vent ( ) Not Applicable
Heat Loss K ) As Approved O Existing O Not Applicable Value
BTU Rate r As Per Plan ( ) Variable ( ) Other Value
Use /Nature SFR / DUG I WORK REMODELING
of Work
Fees: Valuation $1,000.00 Plan Approval $0.00 Permit Fee Paid $20.00
Issued By: Date 03/14/2001
• , /` ____ 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 1609 W WISCONSIN AVE APPLETON WI 54914 -0 Telephone Number (920) 731 -3002
•
e;
Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903 -1130
N H w c Fax # (920) 236 -5084
Phone (920) 236 -5048
HVAC PERMIT APPLICATION
All fields/information after bold categories must be provided.
Incomplete applications will not be processed.
DATBJ O/
JOB ADDRESS kf (c p Rd CA 00-CC- .
OWNER
CONTRACTOR C l S S-` + /FiG '61C.
CIRCLE ALL APPLICABLE
USE CATEGORY 'SINGLE FAMILY DUPLEX MULTI - FAMILY COMMERCIAL INDUSTRIAL
FUEL GAS OIL ELECTRIC SOLAR SOLID
SYSTEM NEW REPLACE (OT
TYPE ` (ORCED AIR RADIANT STEAM A/C VENT
ELECTRIC HOT WATER SUPPL. CON. BURNER
IS CHIMNEY BEING LINED 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 AS APPROVED EXISTING NOT APPLICABLE
BTU RATE AS PER PLAN VARIABLE OTHER VALUE
NATURE OF WORK: -
VALUE (Including labor and materials) $�-1 - / L ha O ) 0 ' �/ 4z0' D
ELECTRICAL CONTRACTOR
Electrical installation of new /replacement equipment shall be done by licensed
contractors.
Valuation Fees •
$1, 000.01 t o $10,000 . 0 ..».»._.«._.«.».«._.«._.»._....»._.».».»._...._. «. «..» ». ». »._.... «.». «._. « - ..$20.00 for first
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10,000.01 to $ _ _ __ ....... _ - - - _ - - _ -.415 5 .0 0 for first
. $10,000.00 plus $1.00 per $100.00 valuation or part thereof
Over $25,000.00.
._.«._.«._.«.».»._.«._.»..».».».»._ . «._. «. ». ». ». «. «._. «. «. «. _.$305.00 plus $0.50
per $100.00 valuation or part thereof
• Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.