HomeMy WebLinkAbout0143473-HVAC (boiler) CD CITY OF OSHKOSH No 143473
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 150 W 23RD AVE Owner THOMAS W /KATHY S GODDARD Create Date 10/06/2010
Contractor GARTMAN MECHANICAL SERVICES Category 500 - Residential- Heating & Ventilating Plan
Fuel 12!( Gas U Oil U Electric J Solar u Solid
System 0 New Q Replace I ❑ Other
Li Forced Air _J Radiant a Steam U A/C ❑ Vent
U Electric (✓ Hot Water J j Suppl. U Con. Bumer
Chimney Type K ) Chimney A 0) Chimney B O Direct Vent • Not Applicable
Heat Loss K ) As Approved 0 Existing • Not Applicable Value
BTU Rate ( ) As Per Plan 0) Variable • Other Value 100,000 BTU's
Use /Nature SFR/ Installing a hot water boiler. EIV from Slim's Electric.
of Work
Fees: Valuation $1,200.00 Plan Approval $0.00 Permit Fee Paid $28.00
Issued By: Date 10/06/2010
❑ Permit Voided Parcel Id # 1402760000
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 2264 OSHKOSH WI 54903 - 2264 Telephone Number (920) 231 -5530
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.
Oct. 6. 2010 8 : 03AM GMS INC No. 4140 P. 3 n
City of Oshkosh
Division of Inspection Services
P.O_Box 1130
Oshkosh, 'WI 54903 -1130
Phone (920) 236 -5050
Pax (920) 236 -5089
HVAC PERMIT APPLICATION ON THE Mtn
'All information after bold categories must beprovided.
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
I ou ar • a c, ttr' ctor , arti i, at'n • ' ; the P.er it - e , - co i Svst and ha e ade !Ia - funds check here
wan thi •r, as. hr, our ac ,n
' Advisory - For applicable projects, an Electrical Installation Verification forin, signed by tile Electril
Contractor or Homeowner (for installations allowed to be performed by the homeowner) nmst be submitte
with the permit application. Applications submitted without an EIY when such is required, will not be
processed for Pedal tIssuance and will be rammed for completion.
DATE /cat% / 0
JOB ADDRESS /50 Lv -
OWNER 're G e c t
CONTRALTO
CHECK El ALL APPLICAILE
USE CATEGORY
giS Family ❑Duplex ❑Multi - Family I:Rental ❑Commercial ❑Industrial
FUEL Ls DBlectric ❑Solid SYSTEM ❑New
d0il [Solar MR7:plaae
El Other
.TYPE
CIForced Air :O.Ra.diant ❑Steam I:A/C OVent OBlectrie
trot wester ❑snppl. Acon. Burner
IS CHIMNEY ING LINED lco DYes - LINER SIZE & MANUFACTURER
Note: All Chimneys shall be sized per the BTUs being vented.
cmMNEY TYPE dChimney A L e imne B DDirect Vent ❑Other
MO. LOSS . DAs Approved afrAisting
TII BATE I~IAs Pu' 4Vaiiabl I31C /t ONot r Value vLGet VBIue / O o o u D r3 TVS
'DESCRIPTION / SCOPE OF ALL WORK BEINGDONE h II , :ca.; of
VALUE (Including labor and materials) $ /02.00 ' a
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
•
07/07
Received Time Oct. 6. 2010 8:02AM No.3130
Oct. 6. 2010 8 : 03AM GMS INC No. 4740 P. 4
City ero ireo h
g
efIrpoodos
1:
POUR WO
oaf Wt 34903 -130
yojj on* 9262364030
Electric Installation Verification
I (We) SLIM'S ELECTRIC INC.
(Electrical Contractor Name)
2608 Oakwood Circle Oshkosh WI 54904
(Address) (City) (S (Zip Code)
have been contracted to perform electric installation work for jp
(Name of party contracted to)
at the following address: W
(Address where work will be performed)
The nature of the work consists of (Cluck One or Describe the Nature of Work)
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 wee 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 pemiaaently wired
appliances) fixtures.
New circuit for the addition of A/C to an lndividuat dwelling twit (house or the
individual systems in a duplex or condominium), inelnding:aNaed service
electrical outlets.
Other
ev
The value of this work is $ _ .
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
raquii teem.
v„,.„49, Youn iy W(Cs) ( I t�
(Signature of , , 0 ' ear) (Print Name of O (Date)
Soz
Received Time Oct. 6. 2010 8:02AM No. 3130