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HomeMy WebLinkAbout0143248-HVAC (furnace & a/c) 0 CITY OF OSHKOSH No 143248 OSHKOSH HVAC PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 407 N LARK ST Owner BRIAN R BOTTERMAN • Create Date 09/21/2010 Contractor CJ MARTIN HEATING & NC Category 502 - Residential -Both Plan Fuel U Gas U Oil Li Electric Li Solar Li Solid System n New Q Replace [] Other Forced Air n Radiant U Steam a NC n Vent U Electric f Hot Water U Suppl. Li Con. Burner Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent • Not Applicable Heat Loss ) As Approved () Existing • Not Applicable Value BTU Rate ) As Per Plan () Variable • Other Value Use /Nature SFR / Replace furnace and a /c. EIV signed by JP Electric. of Work Fees: Valuation $4,600.00 Plan Approval $0.00 Permit Fee Paid $79.00 Issued By: Date 09/21/2010 • ❑ Permit Voided Parcel Id # 1609630000 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 112 ROSALIA ST OSHKOSH WI 54901 - 0 Telephone Number (920) 410 -3558 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 OJHKOJH 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 participating in the Permit fee Account System and have adequate funds, check here if you want this processed through your account fl ** 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 f . ZI / D JOB ADDRESS Lto 7 Lori SI OWNER & i 40 1j0 tiff mar CONTRACTOR CHECK IZI ALL APPLICABLE USX CATEGORY S ingle Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial FUEL [26s ❑Electric ❑Solid SYSTEM C3'New ❑Replace ❑Oil ❑Solar ❑Other T orced A ❑Radiant ❑Ste ©A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner IS CHIMNEY BEING LINED No ❑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 / SCOPE OF ALL WORK BEING DONE /thiA) -t4' (P- M VALUE (Including labor and materials) $ 7 6 00 ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) 07/07 Sep 21 10 02:29p Jim & Wend Pollnow 920- 235 -1000 p.1 City of Oshkosh CAII) Division of Inspection Services 215 Church Avenue PO Box 1130 Oshkosh WI 54903 -1130 Office 920- 236 -5050 tis w s Fax 920- 236 -$084 Electric Installation Verification I (We) friwi- (' ‘ L C (Electrical Contractor Name or Homeowner's Name) 7 ( `� 6/- £9 L l v S 2 g (Address) 6 (City) (State) (Zip Code) accept the responsibility to perform the electric work as stated below, 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) T Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser. Reconnection or new circuit for replacement Electric Water Heater or power vented 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 the replacement of other permanently wired appliances / fixtures. New circuit for the addition of A/C to an individual dwelling unit, including required service electrical outlets. Note: Homeowners can only do their own electric on a single family owner occupied home. Work on a condominium, duplex, rental, or multi -use building would require a licensed Electrical Contractor. Other The value of this work is $ (.26 • . I hereby verify this work will be performed in compliance with the License requirements of Section 11 -22 of the Oshkosh Municipal code and further verify the reconnection / installation will be done in compliance with manufacturer and Electric code requirements. J 1w! Rifivav y / s i gn � ature of Company Officer or Homeowner) (Print Name) (Date) Received Time Sep. 21. 2010 2:27PM No. 2910