HomeMy WebLinkAbout0100417-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
.lob Address 1026 COOLIDGE AVE
Contractor DRUCK'S PLBG & HTG & CLG
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner KATHY K FREES
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type IO ChimneyA ~ Chimney B
Heat Loss I~ As Approved O Existing
BTU Rate I~ As Per Plan O Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
100417
03/26/2003
Other J
Vent J
40m
Use/Nature SFR/Replace furnace, A/C & line chimney. *EIV form from MY Electric.
of Work
Fees: Valuation
Issued By:
$4,068.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$66.50
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 504 3RD ST P O BOX 355 MENASHA WI 54952 - 0
Telephone Number
(920) 426-2654
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
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.
O,/'HKO_/H
ON THE WATER
· 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 5;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
CHECK [] ALL APPLICABLE
USE CATEGORY
~gingle Family [2Duplex
F1Multi-Family
F1Rental
[2Commercial
[3Industrial
FUEL ,IE[Gas [3Electric F1Solid SYSTEM
[]Oil FISolar
F1New l~Replace
[3Other
TYPE
J2(Forced Air []Radiant []Steam F1A/C []Vent FlElectric
IS CHIMNEY BEING LINED UINo [~/es - LINER SIZE
Note: All chinmeys shall be sized per the BTU's being vented.
[]Hot Water F1Suppl. F1Con. Burner
& MANUFACTLrRER
CI-HMNEY TYPE
HEAT LOSS
BTU RATE
[Sg2himney A
r'iAs Approved
FIAs Per Plan
[]Chimney B F1Direct Vent F1Other
[~Existing [:]Not Applicable
[2Wariable [3Other Value .fi/f.,
DESCRIPTION oF ALL WORK BEING nONE
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CO TRACtOR
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
MAR-04-2003 12:40 HY ELECTRIC CORP. 920 232 8900 P.01
Electric Installation Verification
I(%Vc). MY El,ectric, Corp.
(Elecu ic~t Contractor Name)
1512 Rugby_St. Oshkosh W! 54902
(Address) (City) (State)
have been contracted to perform electric installation work for ,Druc_:.ks p lumblng
(Name of party contracted to)
atthe followingaddrcss: 1026 Coolidge Ave. ~ 0shkosh~ WI
(Address where work will be pe~£O~rned)
The nature of the work consists of: (Check One or Descr/bc the Nature o£Work)
X
(Zip Code)
l~econnection or new circuit for replaccmcnt Heating Plant andYor A/C Condenser.
R. econn~ction or new circuit for replacemcnt EIectric Water Heater or power vented
water h~ater.
Reconnection of'the Service Entrance Cable, Meter Box, alterations Co receptacles
and lightiag fixtur~ due to sid/ng / soffit installation. Note: New Service
F. ntrance Cables will require a separate permit. '
Keconnection or new circuit for the replacement of'other permanently wired
appliance~/'fixtures.
New cir~uk for the addition of A/C to an individual d, veiling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $,,$500. O0 or Less
I htreby verify this work will be performed by au employee of this company and further verify
the rccormectiou / installation will be done in compliance with manufacturer and Electric cede
requirements.
Eric Youn~bau~.r
(Print Name of Omc fl----
,,, 3 /4 ./2o03 ....
(Date)
TOT~qL P. 01