HomeMy WebLinkAbout0143274-HVAC (furnace) 0 CITY OF OSHKOSH No 143274
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2525 VILLAGE LN Owner ROBERT J /MONICA M PENZENSTADLER Create Date 09/23/2010
Contractor BLACK -HAAK HEATING Category 500 - Residential- Heating & Ventilating Plan
Fuel ❑✓ Gas Oil ❑T Electric ❑ Solar [j Solid
System ❑ New ✓ Replace ❑ Other
Q Forced Air ❑ Radiant E Steam ❑ NC Li Vent
❑ Electric Q Hot Water ❑ Suppl. ❑ Con. Burner
Chimney Type 0 Chimney A
Chimney B i Direct Vent 0 Not Applicable_
Heat Loss 0 As Approved • Existing _ ❑ Not Applicable Value
BTU Rate aAs Per Plan Variable Other Value
Use /Nature CONDO / REPLACE FURNACE, EIV SIGNED BY KRUEGER ELECTRIC * *check #23216
of Work
I I
Fees: Valuation $5,000.00 Plan Approval $0.00 Permit Fee Paid $85.00
Issued By: } Date 09/23/2010
❑ Permit Voided Parcel Id # 1321210000
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 PO BOX 7075 APPLETON WI 54912 - 7075 Telephone Number 920 - 757 -9990
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 O��l `O � _
Fax (920) 236 -5084
ON THE WATER
PRiin 1CP 35, 00 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 oarticioatinz in the Permit fee Account System and have adeauate funds, check here
if you want this processed throuzh your account
DATE p i � I D
JOB ADDRESS (J1b v► tlage U1 •) MAf 1
OWNER B(719 OJ1 d Yr1D11lCa ,n Xi tdi.i eX
CONTRACTOR B Virg Itai •ea#1 n6
CHECK Ef ALL APPLICABLE
USE CATEGORY
%Single 'Family ClDuplex ❑Multi - Family ❑Rental ❑Commercial ❑industrial
• FUEL '1Gas DElectric ❑Solid SYSTEM ❑New NReplace
❑Oil ❑Solar ❑Other
l F
orced Air ❑Radiant ❑Steam DA/C ❑Vent ❑Electric ❑Hot Water OSuppl. ❑Con. Burner
IS CHIMNEY BEING LINED KNo ❑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 l Other Value
DESCRIPTION OF ALL WORK BEING DONE RQV I C& - u is rP,
VALUE (Including labor and all materials including light fixtures) $pD OD
ELECTRICAL CONTRACTOR . \&L Pi of aethic,
❑ For applicable projects, an Electric stallation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
D �f lt<q>te[134 1AY'4RP♦
r1y cn.uh nKll
• PO BoK WO
(*hlns), Wt S- 0 -11)0
UJ1 -1 �,rl�.� •�w�tit,lsa
O+ ; =M� P. P20-2.1P-30+0a
Electric Installation Verification
(I) (We) l r` a e F- 1 ci C—.�r ^ ,
( ctrical Contractor Name)
1 Le d v' Ad,. L 14 k) ) . L. 0 -- . '/ yv
- (Address) (City) (State) (Zip Code)
have been contracted to pertain) electric installation work for ti tOtek t 11C e t r1
` y/�
(Name of party contracted to)
at the following address: (' `/ 5 1I I i1 O P� Vi 1 • 1 boh s
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
k Reconnection or new circuit for replacement Heating Plant and'or AJC 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:
cab ica will require a separate permit.
_ Reconnection or new circuit for otherpettnanently.vrired appliances / fixtures.
Other
The valt:e of this work is $ /S -00
1 hereby verify this work will be performed by an erap loyee of this catnpany and furtherr verify the
reconnection / installation will he done in compliance with manufacturer and Electric code
requirements.
W 0. 1 Cl iN 1s y / o
(Signatuzc o Co y Officer) (Print Name of Offic4 (Date)
Pri RE d Zf,FfL'GL43r.6 1 0:BT EGO', /;T, "+(+