HomeMy WebLinkAbout0144122-HVAC (furnace) 0 CITY OF OSHKOSH No 144122
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 121 MILL ST Owner LYNN A BUHROW Create Date 11/17/2010
Contractor MARTENS HEATING & COOLING Category 500 - Residential- Heating & Ventilating Plan
Fuel U Gas u Oil ❑ Electric 1 J Solar I u Solid
System n New 0 Replace n Other
u Forced Air J Radiant u Steam ❑ A/C Li Vent
Li Electric J Hot Water U Suppl. ❑ Con. Burner
Chimney Type 0 Chimney A 0 Chimney B • Direct Vent 0 Not Applicable
Heat Loss 0 As Approved 0 Existing 0 Not Applicable Value
BTU Rate 0 As Per Plan 0 Variable 0 Other Value
Use /Nature SFR / Replace furnace. EIV signed by Ace Electrical Services. *"`debit acct
of Work
Fees: Valuation $1,493.00 Plan Approval $0.00 Permit Fee Paid $32.50
Issued By: a Date 11/17/2010
❑ Permit Voided Parcel Id # 0801700000
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 514 OMRO WI 54963 - 514 Telephone Number 920 -685 -0111
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 (� r _�(��� I
Fax (920) 236 -5084 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 are a contractor participating in the Permit fee ,Account System and have adequate funds, check here
if you want this processed through your account ri
DATE )/ - /3 /0
JOB ADDRESS M l in/ 1/ 57+ •
OWNER 1- h n
L(. raw RECEIVED
/ NOV 1 7 2010
CONTRACTOR 1 ' / 3 II '1 I t
DEPA R TMEN E T S O° D F
II
CHECK ALL APFLiCABLE I NSP ECTI ON E
USE CATEGORY
Single Family °Duplex DMulti- Family °Rental °Commercial ❑Industrial
FUEL XGas ❑Electric ❑Solid SYSTEM ONew OReplace
Moil ❑ Solar ❑Other
TYPE
PForced Air []Radiant OSteam DA/C [Went DElectric °Hot Water ❑SuppLDCon. Burner
IS CHIMNEY BEING LINED No DYes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE °Chimney A ❑Chimney B $(Direct Vent DOther
HEAT LOSS DAs Approved °Existing DNot Applicable
BTU RATE DAs Per Plan °Variable °Other Value
DESCRIPTION OF ALL W 1 RK BEING DONE
:1.",f / / ' 4 .....1/I _i.1. -
'
VALUE (Including labor and all materials including light fixtures) $ 14 q3 t DO
ELECTRICAL CONTRACTOR OR 61K Electric Installation verification form attached(If Replacement)
Electrical installation of new /replacement equipment shall be done by licensed contractor.
33.5
3/02
City of Oshkosh
Div ison 215 Church Avenue
Services
PO Hot 1130
Oshkosh WI 5 4902-1130
ON THE WATER fSCt 9 20 - 336. 3050
Fait 5/- 5°5°
Electric Installation Verily
(I) (We) a✓`fi -ten ' ' q 4 / \
(Electrical Cons.. Name) cd edC 'S
d) • w _L/9 7
(Address) (City)
(State) (Zip Code)
have been contracted to perform electric installation work for
(Name of party contracted to)
at the following address: e2 S�
(Address where work will be performed)
The nature of the work consists of : (Check One or Describe, the Nye of Work)
17- Reconnection or new circuit for replaceme Heating
Ramon or new circuit for r Plate and/or A/C Condenser. Electric Water Heater.
Reconnection of the Service Entrance Cable, Meter Box,
lighting fixtures due to siding / soffit installation. Note: � and
Cables will require a separate permit.
Reconnection or new circuit for other permanently wired appliances / fixtures.
Other
The value of this work is
I hereby verify this work will be
reconnection / installation will be done in o� an employee of this company and further verify the
requirements. pliance with manufacturer and Electric code
(Signature of �
.,y Officer) /CX .. J Ue c
(Print Name of Officer) (Date)