HomeMy WebLinkAbout2010-HVAC (furnace) CITY OF OSHKOSH No 144236
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 3820 PURPLE CREST DR Owner HEATH D /SHANNON L PETERS Create Date 12/01/2010
Contractor BLACK -HAAK HEATING Category 500 - Residential- Heating & Ventilating Plan
Fuel 111 Gas L Oil Li Electric L Solar ] Solid
System ❑ New Q Replace 1 [] Other
J Forced Air L Radiant u Steam u A/C _f Vent
U Electric Li Hot Water Li Suppl. Li Con. Burner
Chimney Type u Chimney A 0 ) Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved • Existing O Not Applicable Value
BTU Rate K ) As Per Plan 0 Variable • Other Value
Use /Nature SFR / Replace furnace. EIV signed by Krueger Electric.
of Work
Fees: Valuation $2,000.00 Plan Approval $0.00 Permit Fee Paid $40.00
Issued By: a /1-1 tC. Date 12/01/2010
11 Permit Voided I Parcel Id # 1261470000
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 7075 APPLETON WI 54912 - 7075 Telephone Number 920 - 757 -9990
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 Oshkosh
17iv1th sion of nIns nspection Sernczs
P.O. Box 1130
Oshkosh, WI 54903 -1130 (111111
Phone (920) 236 -5050 01HK01�
Fax (920) 236 -5084
ON THE WATER
Pam i+ CH lip, 0 0 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 trailed 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 adeauate funds, check here
if you want this processed through your account (l
DATE r
JOB ADDRESS V10 VI,i r p) tJ xt IX . 1 ( hK.oSn
OWNER H ea4 1 CJ1lct S)1G'Lrmai
CONTRACTOR 131.aiir. j-kui,L4 n91 ni
CHECK Ei ALL APPLICABLE
USE CATEGORY
(Single Family DDuplex ❑Multi- Family ❑Rental DCommercial ❑Industrial
FUEL [Gas ClElectric ❑Solid SYSTEM ��th �lReplace
er
❑Oil ❑Solar
TYPE
l lForced Air ❑Radiant ❑Steam ❑AJC ❑Vent ❑Electric DHot Water ❑Suppl. ❑Con. Burner
IS CEIIVINEY BEING LINED ijNo ❑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 C lOther Value
DESCRIPTION OF ALL WORK BEING DONE Mi iimT1
VALUE (Including labor and all materials including light fixtures) $ 000
ELECTRICAL CONTRACTOR C 4 k' E1 e( —n (% I f l
0 For applicable projects, an Electric In Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
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city er esnanu ,
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kaik.h WI S490/-11 )0
UJ1-KOIH vow', .30-a.3,4-00 ,tee Put 910.21i
Electric Installation Verification
(I) (We) Kr e
( ctrical Contractor Name)
l
f ro 9 VA A L �o I ��) L.(' f 0 - 17_ / I/ v
(Address) (City) ' (State) (Zip Code)
have been contracted to perform electric installation work for ' 5 I Ctt/K ft H ea(,l fig 1 r
L (Name of party coutractod to)
at the following addreys: _ 3 p OX) NA/9)6 Cre3+ Pr, Q D h
—
(Address where work will be performe(1)
The nature of the work consists of : (Check One or Describe the Nature of Work)
_ Reconnection or new circuit for replacement Heating Plant aldior AJC Condenser.
Reconnection or new circuit for replacement Electric Water Heater,
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacle;: and
lighting fixtures due to tiding soffit installation. Note: New Service Entrance
Ca.hlcs will require a separate permit.
Reconnection or new circuit for other permanentlywired appliances / fix lures.
Other
The value of this work is S/SD• 00
f hereby verify this work will be performed by an employee of this company and further verify the
reconnection / installation will be done in compliance with manufacturer and Electric code
requirements,
W a c. f t� , nJ -rr- aCI I 0 ..
(Sipnatuxc o Com y Officer) (Print Name of Offic (Date)
F.n ?r -lei 7,566Lg O 6 i n:oor cgOVh7/ "fie