HomeMy WebLinkAbout0144358-HVAC (boiler) II CITY OF OSHKOSH No 144358
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1717 ONTARIO ST Owner LINDSAY L GALICA Create Date 12/13/2010
Contractor BLACK -HAAK HEATING Category 500 - Residential- Heating & Ventilating Plan
Fuel u Gas U Oil U Electric Solar Solid
System ❑ New 1 121 Replace 1 ❑ Other
HI Forced Air HI Radiant u Steam HI NC u Vent
Li Electric 11 Hot Water U Suppl. u Con. Burner
Chimney Type I) Chimney A () Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved ❑ Existing • Not Applicable Value
BTU Rate 0 As Per Plan 0 Variable • Other Value
Use /Nature SFR / Replace boiler. Install 4" chimney liner. EIV signed by Krueger Electric.
of Work
Fees: Valuation $4,000.00 Plan Approval $0.00 Permit Fee Paid $70.00
Issued By: /-2.--i Date 12/13/2010
❑ Permit Voided Parcel Id # 1211070000
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 of Oshkosh
∎vision of Inspection Services
..O. Box 1130
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050
Fax (920) 236 -5084 CZATI
�Y 11i � 8 1 D Q All HVAC information PERMI bold T categories PLICATIION 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 $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account r
** Advisory - For applicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by the homeowner) must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
DATE IrNID
JOB ADDRESS 11 17 (M7 fl ) OShKO
OWNER 1.A riA5N e f a L.;
CONTRACTOR V t i ral�,K e th r In DEC 13 2010
CHECK ALL APPLICABLE DEFART(L "J 9F
USE CATEGORY INSPECT I IS JN
1S ingle Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
FUEL Gas DElectric ❑Solid SYSTEM ❑New [XXReplace
❑Oil ❑Solar ❑Other
TYPE ($D' )e,►'
❑Forced Air :Radiant ❑Steam DA/C ❑Vent DElectric wHot Water ❑Suppl. DCon. Burner
IS CHIMNEY BEING LINED ❑No OYes - LINER SIZE 4 ti LJ t%rc MANUFACTURER 11 1/1suxc
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B DDirect Vent DOther
HEAT LOSS DAs Approved t%Existing ❑Not Applicable
BTU RATE DAs Per Plan [Wadable § Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE l a re, hQ i I e,
VALUE (Including labor and materials) $ 000 LO
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) KIWa a.--n &
l 07/07
city oresn.aN,
1111..!!) • rua,�,�r
i5
Po Bok,13G
0/171 unk,1 ia� }O � ., �
W+ 920-2.1,' -i0na
Electric Installation Verification
(I) (We) �_.... C r E- I CZcA
(ctrical Contractor Name)
1 Vat n Le-0c �� i . I I l / L.�i 'C. T:
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for V31aG k,K -►eat1 ne1nc.
(Name of party contmctod to)
at the following addreys: 1� 11 D 6,0 J1 , oshKOSh
(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 andior AJC Condenser.
Reconnection or new circuit for replacement E]ectric 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
Ca.blca will require a separate permit,
.Reconnection or new circuit for other permanently r peanently vrired appliances / fixtures.
Other
the valno of this work is S 150 , 0O
f hereby verify this work will be performed by an employee of this company and Anther verify the
reconnection / installation will he done in compliance with maitttfacturer and Electric code
requirements.
J f, J / W0- �c l�. fr i
5i a ttire o /7./
m c � y •ffi 0-r) (Print Name of CJf6cc0 (Date)
a,FG.' LOE6 0n:BT E9f3L /AT"