HomeMy WebLinkAbout0100408-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
,Job Address 1236 ALGOMA BLVD
Contractor
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
GRANT SCHULTZ HEATING & COOLING
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner DANIEL R DAVIS/B D NEISEN
Category 502- Residential-Both
Electric
Replace
Steam
Suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved ~ Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
100408
03/26/2003
Other J
Vent J
Use/Nature SFR/Replace furnace, new A/C * Homeowner EIV form attached
of Work
Fees: Valuation
Issued By:
$2,820.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$48.50
Date 03/26/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1411 S MAIN ST Oshkosh WI 54902 - 0
Telephone Number
(920) 216-1616
Mar 26 03 08:54a Grant Schult~ Ht~ &
City of Oshkosh
Division of Impecfion Services
P,O. Box i 130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
ON THE ',A~ATFR
· Application(s) and fee(s) can be brought to City Hail, Room 205 or mailed to Iuspeetion Services, PO Box ! 128,
Oshkosh WI 54903-1128. Co~eing work without permit(s) will result in fees being doubled or $100.00 plus the
normal penuit fee, which ever is greater.
OR
If you are a contrac, tor participating_in the Permit fee Account System and have ~d~quate,funds, check here
if vou want this t~rocessed throu~h ~our account ['~ /~ ~-~ ' /3 '
DATE L/ ~,
CFIECK I~ ALL APPLICABLE
USE CATEGORY
[~Single Family FIDuplex
FlMulti-Family E3Rental FlCommercial E3Industrial
FUEL ~Gas I-IElectric E3Solid SYSTEM IZINew ~Replaee
r'lOil V1Solar [ZlOther
TYPE
~lForced Ak IZIRadiant OSteam 0ilA/C UIVent ElElectrie 12]Hot Water I2]Suppl. EICon. Burner
IS CI-IIMNEy BEING LINED ~No I-lYes - LINER SIZE
Note: Ail chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CFIIMNEy TYPE FlChimney A r'lChimney B ~{~Direot Vent ElOther
HEAT LOSS I-lAs Approved IDExisting IDNot Applicable
BTU RATE FlAs Per Plan E]Variable ?Other Valu.~ /~ ~/~(...
DESCRIPTION OF ALL WORK BEING DONE '~-~lal~--_~ ~/~,-r~:~ ~...,~.. eld~
VALUE (Including labor :md all materials/i~eluding light fixtures)
ELECTRICAL CONTRACTOR
[] For appli~able projects, an Electric Installation Ve~fieafion form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/'02
Mar 26 03 08:54a Grant Schu]tz HtC & R?C (9201237-4959 p.1
l (We)
/ Elect~ Installation Verification
the homeowner(s) of
(print homeowner(s) name)
(address whY're work is to be performed)
accept the responsibility for performing the electrical work as stated below for the property listed
above.
The nature of the work consists of: (Check one or Describe the Nature of Work)
d Heconnecfion 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.
Reconneetion of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding I 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. Y~ork on a condominium,
duplex, rental, or multi-use building would require a licensed master
electrician.
Other
The value of this work is $.. 2 ~ ZO, ~
I hereby verify this work will be performed by me and further verify the reconneetion /
installation will be done in compliance with manufacturer and Electric code requirements.
c.. ...... ; ........ Homee'%v~ngr(s) Signature~ (Date)
5/02