HomeMy WebLinkAbout0144144-HVAC (furnace) C I CITY OF OSHKOSH No 144144
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 280 GRACELAND DR Owner RICHARD C /SUSAN P KNOBLOCH Create Date 11/18/2010
Contractor DRUCKS PLUMBING & HEATING CO IN( Category 500 - Residential- Heating & Ventilating Plan
Fuel ✓ Gas U Oil Electric
J Solar L Solid
System [] New I 4 Replace
❑ Other
Li] Forced Air ❑ Radiant u Steam u NC u Vent
U Electric LI Hot Water U Suppl. U Con. Burner
Chimney Type 0 Chimney A 0 Chimney B O Direct Vent O Not Applicable
Heat Loss ( ) As Approved 0 Existing • Not Applicable Value
BTU Rate ( ) As Per Plan () Variable • Other Value
Use /Nature SFR / Replace furnace. EIV signed by Drucks Electric.
of Work
Fees: Valuation $4,089.00 Plan Approval $0.00 Permit Fee Paid $71.50
Issued By: (,,r'M,Q/ Date 11/18/2010
❑ Permit Voided I Parcel Id # 0618340000
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, WI 54903 -1130
Phone (920) 236 -5050
Fax (920) 236-5084 OiHK /H
Cr, -.ar ,•. rr�
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 - 128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
Lf 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 fl
** 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 retained for completion.
DATE //- 7
JOB ADDRESS ;(, t; letC,e/.fie, E OWNER Xc44 /-j/106/0e • t D
CONTRACTOR auc,S fl /0to y //i24 /� /c'c�r,� NOV 1 8 2010
CHECK C� ALL APPLICABLE DEPARTMENT OF
COMMUNITY DEVELOPMENT
USE CATEGORY INSPECTION SERVICES DIVISION
EPS ingle Family ❑Duplex ❑Multi Family ❑Rental ❑Commercial ❑Industrial
FUEL bias ❑Electric ❑Solid SYSTEM ❑New WReplace
0Oi1 ❑Solar ❑Other
TYPE
*Forced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED No ❑Yes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A Chimney B ODirect Vent ❑Other
HEAT LOSS As Approved ❑Existing ONot Applicable
BTU RATE PLAs Per Plan ❑Variable ❑Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE AP¢le ,e2e7,04'e
VALUE (Including labor and materials) $ ye 4 i I • .5
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
07/07
Ciry of Oshkosh
Division of Inspection Services
215 Church Avenue
PO Box 1130
Oshkosh WI 54903 -1130
Office 920-236-5050
w Fax 920 -236 -5084
Electric Installation Verification
I (We) /4l1001A- ,UY-e-
(Electricalce''ontractor Name or Homeowner's Name)
` ' 5/ 9 43,/M //7 le0 14 f 11/,,' J` ?
(Address) (City) (State) (Zip Code)
accept the responsibility to perform the electric work as stated below, at the following address:
x36 ��4« i 1 dr a
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
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, including
required service electrical outlets. Note: Homeowners can only do their own
electric on a single family owner occupied home. Work on a condominium,
duplex, rental, or multi -use building would require a licensed Electrical
Contractor.
Other
The value of this work is $ e'6
I hereby verify this work will be performed in compliance with the License requirements of
Section 11 -22 of the Oshkosh Municipal code and further verify the reconnection / installation
will be done in compliance with manufacturer and Electric code requirements.
f / r-r- //( 4—
(Signature of Company Officer or Homeowner) (Print Name) (Date)
07/07