HomeMy WebLinkAbout2010-HVAC (furnace & a/c) I0 CITY OF OSHKOSH No 143783
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 200 S LARK ST Owner STEVE R LANGKAU Create Date 10/22/2010
Contractor DRUCKS PLUMBING & HEATING CO IN( Category 502 - Residential -Both Plan
Fuel 111 Gas U Oil 1 Electric U Solar I Solid
System 0 New 1 0 Replace n Other
U Forced Air u Radiant u Steam J A/C LI Vent
U Electric U Hot Water U Suppl. U Con. Burner
Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent 0 Not Applicable
Heat Loss 10 As Approved 0 Existing • Not Applicable Value
BTU Rate 0 As Per Plan 0 Variable • Other Value
Use /Nature SFR / Replace furnace and a /c. EIV signed by Drucks Electric.
of Work
Fees: Valuation $7,800.00 Plan Approval $0.00 Permit Fee Paid $127.00
Issued By: a/71,0- 4 Date 10/22/2010
❑ Permit Voided I Parcel Id # 0608650400
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 P 0 BOX 355 MENASHA WI 54952 - 355 Telephone Number 920 -426 -2654
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, W1 54903 - 1130
Phone (920) 236 -5050 •
Fax (920)236-5084 OJHKOJH
ON THE WATFR
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 area contractor partictpattnz 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.
Op j Ltrk 1 . DATE JOB ADDRESS � •4 6l..41l.,
OWNER 1. *-€ 3 R E
CEIV
CONTRACTOR !'uc �S l u Ia,a d d�C ¢- .t / « f j ,�. ED
e OCT2 &201
0
CHECK 10 ALL APPLICABLE. � °EPARTN NT OF
COMMUNITY DEVELOPMENT
USE CATEGORY INSPECTION SERVICES DI ISION
C} Single Family ❑Duplex DMulti- Family DRental D.Commercial Dlndustrial
•
FUEL 11§Gas DElectric i Solid SYSTEM ❑New INReplace
DOil DSolar DOther
TYPE •
fdForced Air :Radiant OSteam ®A /C DVent DElectric OHot Water DSuppl. DCon. Burner . •
IS CHIMNEY BEING LINED IiikNo DYes. - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
•
CHIMNEY TYPE Chimney A DChimney B ❑Direct Vent DOther
HEAT LOSS As Approved DExisting DNot Applicable
BTU RATE lEAs Per Plan DVariable DOther Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE . I ,/ / 6 -e rr'Ld 4/ l
FF+�nfce 7 � ,
�l /vie , • •
VALUE (Including labor and materials) $
ELECTRICAL CONTRACTOR (for projects not requiring an ETV Form)
07/07
•
City of Oshkosh
Division of Inspection Services
215 Church Avenue
PO Box 1130
Oshkosh WI 54903 -1130
• ,,
UZ•1 m Office 920- 236 -5050
• WA Fax 920- 236 -5084
Electric Installation Verification
I (We) ve 4 wr or , t i U'iC ?- e ',.
(Electrical Contractor ame or Homeowner's Name)
(Address) (City) (State) (Zip Code)
accept the responsibility to perform the electric work as stated below, at the following address:
;oa J Z.-q f i '3f; .0'47 �Cc � . �cJ,-
(Addre s where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
X Reconnection or new circuit for replacement Heating Plant and/iT A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Se ice Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Service
Entrance Cables ' require a separate permit.
Reconnection or new c' icuit for the replacement of other permanently wired
appliances / fixtures
0 New circuit for the addi ;on of A/C to an individual dwelling unit, including
required service ele •trical outlets. Note: Homeowners can only do their own
electric on a single 'may owner occupied home. Work on a condominium,
duplex, rental, or m lti -use building would require a licensed Electrical
Contractor.
Other
I
The value of this work s $ a---4" ti
I hereby verify this wo will be perf rmed in compliance with the License requirements of
Section 11 -22 of the O'bkosh Muniei al code and further verify the reconnection / installation
will be done in compli. ce man acturer and Electric code requirements.
d .' r4
( AT fr
/o// 211c7
(Signature of Company Office or Homeowner) (Print Name) (Date)
07/07
li