HomeMy WebLinkAbout0144359-HVAC (furnace) l CITY OF OSHKOSH No 144359
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1402 EVANS ST Owner ROBERT J BRICCO Create Date 12/13/2010
Contractor BLACK -HAAK HEATING Category 500 - Residential- Heating & Ventilating Plan
Fuel L Gas U Oil Li Electric U Solar ] Solid
System ❑ New 1 121 Replace [] Other
u Forced Air J Radiant _J Steam _J NC u Vent 1
Li Electric Li Hot Water U Suppl. U Con. Burner
Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent • Not Applicable
Heat Loss As Approved • Existing Not Applicable Value
BTU Rate 0 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: la/!/ Date 12/13/2010
❑ Permit Voided I Parcel Id # 1508710000
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
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050
Fax (920) 236-5084
N H WA
HVAC PERMIT APPLICATION
Tel l i 1 - R 4 L4 D 00 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 n
** 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.
`' vn DATE
JOB ADDRESS l D' EVOXS J • 1 Q hM1SYi
OWNER ibrIcto RECPIVED
CONTRACTOR B I d < - - Ctt -K HecktI nG t n C
DEC 13 2010
CHECK ® ALL APPLICABLE iEp;ii E
COMMU .Tr' DE, E!
USE CATEGORY INSPECTION ION SERVI ij i:jQ'
bASingle Family ❑Duplex DMulti-Family ❑Rental ❑Commercial Industrial
FUEL Gas DElectric ❑Solid SYSTEM ❑New IXlReplace
❑Oil DSolar DOther
TYPE
OForced Air DRadiant ❑Steam DA/C ❑Vent DElectric DHot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED IINo DYes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B DDirect Vent ttlOther
HEAT LOSS DAs Approved NExisting ❑Not Applicable
BTU RATE DAs Per Plan DVariable 040ther Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE RbpIare> fiArnarP
VALUE (Including labor and materials) $ 91 000 . 00
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) Q.,1 e r EI ec c
J 07/07
chy orc zunu
11(1-11:F) 1 1Nf+� of Iru{ PS [1n4
2 1 .1xn.
219 c'Mr■A nw„w
PO Box 112(1
t l.htsnsh W 1 4-1V01.11 )Q
UJH CJH 01119" *faa,ti5
Electric Installation Verification
(I) (W e) r` to cc.- a •
( ctrical Contractor Name)
1 Yo V .. Ace', ro e k
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for 11 (,K aaki -Ieilfin ne__.
(Name of party corn o)
at the following address: (�p� �U<� �S 1 , 05h kosl1
(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.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles and
lighting fixtures due to siding! soffit installation. Note: New 5crYiee Entrance
Cables will require a separate permit,
Reconnection or new circuit for other permanently.wired appliances / fixtures.
Other
The value of this work is $I SO. DO
[ hereby verify this work will he performed by an employee of this cotnpany and further verify the
reconnection / installation will be done in complian.cc with manufacturer and Elegtz code
requ irern ents.
_CD � II II 1 LL
(Siglatuzc o Com y Officer) (Print Narne of Offic (Date)
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