HomeMy WebLinkAbout0143458-HVAC 0 1 CITY OF OSHKOSH No 143458
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Owner MERCY MEDICAL CENTER OSH INC Create Date 10/05/2010
Contractor BASSETT MECHANICAL Category 512 - Ind. & Comm -Both Plan 09- 3159 -1010
Fuel u Gas ❑ Oil U Electric Li Solar U Solid
System ❑ New Q Replace 0 Other
Li j Forced Air ❑ Radiant u Steam ✓J A/C 4 Vent
Electric Hot Water Li Suppl. U Con. Burner
Chimney Type 10 Chimney A 0 Chimney B () Direct Vent 0 Not Applicable
Heat Loss 0 As Approved 0 Existing 0 Not Applicable Value
BTU Rate • As Per Plan 0 Variable 0 Other Value
Use /Nature Angiography Suite Renvovation - Removal of old grills, addtiion of new, ass 1 VAV box, Hot water piping and insulation w/ duct as per
of Work plans.
Fees: Valuation $14,500.00 Plan Approval $0.00 Permit Fee Paid $205.00
Issued By: Date 10/05/2010
❑ Permit Voided Parcel Id # 0613660000
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 7000 KAUKAUNA WI 54130 - 7000 Telephone Number 800 - 236 -2500
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 a1HKa.IH
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 f
** 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. / j O '� c o�dckac cA0 DATE
JOB ADDRESS /III Q - R -s 3 A
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CONTRACTOR
SEP 1 6 2010
CHECK 10 ALL APPLICABLE DEPARTMENT OF
COMMUNITY DEVELOPMENT
USE CATEGORY INSPECTION SERVICES DIVISION
❑Single Family ❑Duplex ❑Multi - Family [Mental Vommercial ❑Industrial
FUEL ❑Gas DElectric ❑Solid SYSTEM ❑New ❑R eplace // JJ
DOH ❑Solar Ether ( � M - / 4 V' /7/f)
T
orced Air ❑Radiant ❑Steam ❑A/C ❑Vent DElectric HHot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED DNo DYes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent DOther
HEAT LOSS DAs Approved DExisting ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable DOther Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE # , • ,e !,: t
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VALUE (Including labor and materials) $ , r) . . - L 1 " _ (9a5", = �
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
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