HomeMy WebLinkAbout0143921-HVAC (furnace) l CITY OF OSHKOSH No 143921
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1565 MARICOPA DR Owner DONALD R SIMONS /G M SCHAEFFER Create Date 11/03/2010
Contractor E C MERRILL INC Category 500 - Residential- Heating & Ventilating Plan
Fuel ✓ Gas Oil Electric 1 J Solar U Solid
System —] New 1 0 Replace I [- Other
u Forced Air u Radiant u Steam J A/C u Vent
Li Electric Li Hot Water Li Suppl. [J Con. Burner
Chimney Type u Chimney A 0 Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved 0 Existing • Not Applicable Value
BTU Rate `) As Per Plan 0 Variable 0 Other Value
Use /Nature SFR / Replace furnace. EIV signed by Kollmann Electric.
of Work
Fees: Valuation $4,400.00 Plan Approval $0.00 Permit Fee Paid $76.00
Issued By: Date 11/03/2010
❑ Permit Voided Parcel Id # 1319350000
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 o secur any ne. s- ♦ a.provals before starting such activity.
Signature 4470— ����t�� //
Date // -- r le9
Agent/Owner
Address 1018 W SOUTH PARK AVE OSHKOSH WI 54902 - 0 Telephone Number (920) 235 -3600
To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Number, Type of
Inspection (Le. 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.
1
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050
Fax (920) 236 -5084 OJHKOJ H
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 S100.00 plus the
. normal permit fee, which ever is greater.
OR
!.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 n
DATE //�3 /O
JOB ADDRESS /.54.5 114,ev 'lJr', 2-
OWNER t AJ 5/71704/-s CONTRACTOR E . P. /47e,e,' -tic .
CHECK ® ALL APPLICABLE
USE CATEGORY
(C.Single Family °Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
FUEL IZIGas ❑Electric °Solid SYSTEM ONew 121Replace
DOiI ❑Solar ❑Other
TYPE
Forced Air ❑Radiant ❑Steam OAIC °Vent ❑Electric °Hot Water DSuppl. ❑Con. Burner
IS CHIMNEY BEING LINED ONo ❑Yes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A °Chimney B °Direct Vent ❑Other
HEAT LOSS DAs Approved ❑Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable °Other Value
DESCRIPTION OF ALL WORK BEING DONE
/r24o emi G, 6.0176V 4 67" / 46eit/4-2 u/JM r1 72'.9i✓
ibt/r /4, 5 6 ,40/6,47 7/ 977 » )4 �u / .o ,-
VALUE (including labor and all materials including light fixtures) t 44*, O 1 4 76' e
ELECTRICAL CONTRACTOR T)j_LL ,q4/ eZ6Z 7..0 (
D 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.
Aug. 2. 2005 3:02PM inspection services No. 2457 P. 1
CkY or
ns( b Ado
PO Box }194
Oshiank WI 54903 -1
�y (rT!
: _ i °nice 928431"°S8 Fax 920 - 1,64084
Electric Installation Verification
l (We) Aze,sts)(il
(Electrical Contractor Name)
� n
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for - - (Name ofparty contracted to)
at the following address: /
(Address 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/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance 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 permanently wired
appliances / fixtures.
New circuit for the addition of A/C to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
`� bU
The value of this work is $L
1 hereby verify this work will be performed by an employee of this company and further the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
,/_4( , . _ ..._._. � /7/ ► e- n 1/- 3 — /U
/ (Si ,, re of Company Officer)
(Print ame o O ffiicer) (Date)
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