HomeMy WebLinkAbout0143711-HVAC (furnace) Cii) CITY OF OSHKOSH No 143711
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 609 W 9TH AVE Owner JENNIFER L LISKA
Create Date 10/19/2010
Contractor A -1 HEATING & A/C INC Category 500 - Residential- Heating & Ventilating Plan
Fuel L ✓ I Gas I Li Oil I I Electric 1 I Solar
I 1 1 Solid
System ❑ New 1 n Replace
❑ Other 1
VI Forced Air 1 LJ Radiant _J Steam I ❑ NC
LJ Vent
U Electric I 1 J Hot Water I Li Suppl.
i 1 j Con. Burner 1
Chimney Type 0 Chimney A () Chimney B Direct Vent
U • Not Applicable
Heat Loss I( ) As Approved • Existing 0 Not Applicable I Value
BTU Rate K ) As Per Plan () Variable • Other
Value
Use /Nature SFR / Replace furnace. EIV signed by Bell Electric.
of Work
Fees: Valuation $1,610.00 Plan Approval $0.00 Permit Fee Paid
$35.50
Issued By:
Date 10/19/2010
❑ Permit Voided I Parcel Id # 1303350000
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 W8078 HILLCREST CT HORTONVILLE WI 54944 - 9301 Telephone Number 920 - 779 -8838
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 1 aCHKO j
HVAC PERMIT APPLIC4TION
All information after bold categories must be provided.
Incomplete applications will not be p cessed.
• 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 vou are a contractor
participating in the. Permit fee Account Sv tem and have adequate fiends, check here
if you want this processed through your account f
** Advisory - For applicable projects, an Electrical Installation Verif_cation (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.
P DATE
JOB ADDRESS f -� d IA /1-ira
OWNER Fe• ! R ECEIVE
CONTRACTOR A -1 Renting &A/C OCT 1 9 2010
P.O. Box 311 DEPARTMENT OF
CHECK ® ALL APPLICABLE Hortonville, WI 54944 INSPECTION ER ICES VISION
UV-CATEGORY
Single Family ❑Duplex ❑Multi- Family ❑Rental ❑Commercial ❑Industrial
FUEL MC DElectric ❑Solid SYSTEM ❑New laRtlilace
❑Oil ❑Solar ❑Other
TYPE
l;lfFiirced Air ❑Radiant ❑Steam OA/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED D ❑Yes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent DOther r, ,
HEAT LOSS DAs Approved GlE< sting ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable ❑Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE L _ - _ ,,`_ vol
VALUE (Including labor and materials) $ / C /0 •-
ELECTRICAL CONTRACTOR (for projects not requiring an ETV Form) I/
o?; c "
4 3S
1 V /14 /LVLV £t1U a:.o r/ill y 'u is L/1.3 watters Clumping
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713 Church Avenue
PO 50i. ►1)0
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Electric Installation Ve
4
1cation
(Electrical Contractor No e) --
t
..._. V . ....... _ ., .._. /I 111 e ri� ) I 4/ L S Y 5 S
( Address)
(City) I (State) (Zip Code)
Wye been contracted to perform electric installation work f r _IL—Lifea•d?.17/011 64 /1/C.._...._,
Ia 0' to lot r
(Name of party contracted to)
at the following address: .d. z��`'
(Address where work ill be performed)
The naturcc lacement off the work consists of (Check One or Desalt) the Nature of Work)
—
. !! Reconnection or new circuit fbr re eating rg Flant and /or A/C Condenser.
._ Reconnection or new circuit for replacement lectric Water Heater or power vented
water heater.
___ _. Reconnection of'the Service Entrance Cable. etnr Rem, Atrnratinns to tvrrpiirina
and lighting fixtures due to siciix►$ / soffit i ■stallation. Note: New Service
Entrance Gables will require a separate pe nit.
__ -_.. Reconnection or new circuit for the replaccme 1 of other permanently wired
appliances / fixtures,
_- ._... New circuit for the addition of A/C to an fndjv dual dwelling unit (house or the
incliviclual systems in a duplex or condom' ium), including required service
electrical outlets.
Other
The value of this wank is $ - - - - --�_ - •
1 hereby verify this work will he performed by an employe of this company and further verify
the rc.connection 1 installation will be dune in compliance ith manufacturer. and Electric code
requirements.
.Tai _
l . ��nP,11,r or Company C)f(iccr .I __--� A / <U
1 _ (Print Narnc 0 % /R icer) (Date) -
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