HomeMy WebLinkAbout0144068-HVAC (furnace) 0 CITY OF OSHKOSH No 144068
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 221 LAKE POINTE DR Owner GLADYS C RIETZ Create Date 11/15/2010
Contractor GARTMAN MECHANICAL SERVICES Category 500 - Residential- Heating & Ventilating Plan
Fuel U Gas U Oil J Electric (J Solar J Solid
System ❑ New 1 0 Replace 1 ❑ Other
u Forced Air 11 Radiant ❑ Steam LI NC LJ Vent
u Electric U Hot Water U Suppl. u Con. Burner
Chimney Type j Chimney A ) Chimney B • Direct Vent O Not Applicable
Heat Loss ( ) As Approved • Existing 0 Not Applicable Value
BTU Rate 10 As Per Plan 0 Variable • Other Value
Use /Nature Condo / Replace furnace. EIV signed by Slim's Electric. * *debit acct
of Work
Fees: Valuation $2,950.00 Plan Approval $0.00 Permit Fee Paid $55.00
Issued By: aZY/4 / Date 11/15/2010
❑ Permit Voided I Parcel Id # 0614407514
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.
Nov. 15. 2010„ 32AM GMS INC No, 5695 P . 1/,
Division of inspection Services
P.O. Box 1130 rib*
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050 . N
Fax (920) 236 -5084 r Kali
HVAC PERMIT APPLICATION ON r~E WATER
All information after bold categories must beprovided.
Incomplete applications will not be processed.
• Application(s) and fee(s) cstn 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
aomsal permit fee, which ever is greater.
OR
I ou a'e , co frac or , •rt'i•, fin . 'n a 'er, -e :cc, r t Sstem ',id hay' ade•u, e und. ch -ekhere
i a u w ont this�toce g� h ue h „ acco, ni r∎
'` *Pisary - For applicable projects, an Electrical .
Co
Alvin or or Homeowner (for ' hon Verification (MY) form, signed by the Electrical
( installations allowed to be pexformmed by the homeowner) must be submitted
with the pennit application. Applications submitted without an EIV when such is required, win not be
processed for Peimit Issuance and wit be returned for completion.
DATE / / /IV/ o
JOE ADDRESS Z L, f, o , , k- ,- ,
OWNER tr L +.
CONTRACTOR 6 S ,, , ` _._
CHECK 0 ALL APPLICABLE
USE CATEGORY
mgingle Family LlDuplex DM lti- Family ORental °Commercial DIndustrIal
TJEL LS66 °Electric DSolid
- 00i1 ClSolar SYSTEM l7New 11 lsce
tlOther
j7
edAir :pRndiant DStgam ❑A1C DV `
ent OBlectric Mot Water ❑Supp1. ❑Con, Burner
IS CEINNEY BEING LINED PM °Yes - LlI?TER SIZE
Note: All chimneys sball be Sized per the BTU's being vented. lvlAN[JFACT'(JRBR
BEY TYPE °Chimney A .pc
a�EA�'.�bSS :1r1 eY B =Tract Vent ClOther
s Approved Cuing dNot Applicable
$TC RATE DAs Per plea I lVarihble
Br Value & rJ a __
DESLRIPTIOR / SCOPE OF ALL WORK BEING DONE rt
VALUE (Including labor and materials) ,2 ys
ELECTRICAL CONTRACTOR (for projects not requiring an ETV Form //
07/07
Received Time Nov, 15. 2010 8:31AM No. 3725
Nov. 15. 2010 8:32AM GMS INC No. 5695 P. 2/2
c�ndr oama�
® 21 of A sue,
Po &100
ao k h 34903-1130
•01 ::011:
Ea 920Z76
Electric Installation Verification
I(we) SLIM'S ELECTRIC INC.
(Electrical Contractor Name)
2608 Oakwood Circle Oshkosh WI 54904
(Address) (City) i (State) (Zip Code)
have been contracted to perform electric installation work for • •_ _ . A ' __!
(Name of p contracted •
at the following address: P oud MC
(Address where work will be performed)
The nature oldie work consists of (Check One or Describe the Nature of Work)
Ramon or new circuit for replacement Heating Plant and/or A/C Cotrdemer,
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Ruction 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) fxtures.
New circuit for the addition of A/C to an Individual dwelling snit (house or the
individual systems m a duplex or condominium), including required service
electrical outlets.
Other
L
The value of this wok is $ aco
.... . I hereby verify tb is work will be performed by-an employee this company.and farts verify - .
the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
�• �. '/ _pi9veD119 10es w1
(Signature of Comp; cer) (Print Name of O (Date)
5■112
Received Time Nov. 15. 2010 8:31AM No. 3725