HomeMy WebLinkAbout0091119-HVAC (furnace) (9 CITY OF OSHKOSH No 91119
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1627 MINNESOTA ST Owner JAMES B GRINER & WF Create Date 11/05/2001
Contractor RASMUSSEN'S HEATING & A/C INC Category 500 - Residential- Heating & Ventilating Plan
Fuel U Gas Oil I Electric ] Solar i Solid
System a New 0 Replace 1 [] Other
u Forced Air u Radiant u Steam J NC _I Vent
1 Electric 1 Hot Water 1 1 Suppl. Con. Burner
Chimney Type Chimney A • Chimney B () Direct Vent () Not Applicable
Heat Loss C As Approved • Existing Q Not Applicable Value
BTU Rate ,) As Per Plan () Variable () Other Value 80M
Use /Nature SFR/ Replace existing furnace. *EIV form from Hoehne Electric.
of Work
Fees: Valuation $3,400.00 Plan Approval $0.00 Permit Fee Paid $56.00
Issued By: KM Date 11/05/2001
❑ Permit Voided
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number 920 - 235 -6569
Division of Inspection Services
-215 Church Avenue
P.O. Box 1130
��� Fax 1 249 030130
�� � e
Fax (( (920) 0) 236 -50084
Phone (920) 235 -5048
HVAC PERMIT APPLICATION
All fields /information after bold categories must be provided.
Incomplete applications will not be processed.
DATE 11'5
JOB ADDRESS /60 ill i hn c90+e..
OWNER Phyllis Grc vicr
CONTRACTOR Ri .n a sseirt 5 441,4V-
CIRCLE ALL APPLICABLE
USE CATEGORY 6i;;; ;;413:› DUPLEX MULTI - FAMILY COMMERCIAL INDUSTRIAL
FUEL; OIL ELECTRIC SOLAR SOLID
SYSTEM NEW REPLACES OTHER
TYPE FORCED AIR) RADIANT STEAM A/C VENT
ELECTRIC HOT WATER SUPPL. CON. BURNER
IS CHIMNEY BEING LINED NC LINER SIZE MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE CHIMNEY A CHIMNEY DIRECT VENT OTHER
HEAT LOSS AS APPROVED SXI'� NOT APPLICABLE
BTU RATE AS PER PLAN VARIABLE OTHER VALUE 8C),000
9
NATURE OF WORK:
VALUE (Including labor and materials) $ 3
ELECTRICAL CONTRACTOR �tsc.knc EJc .f'r i L
Electrical installation of new /replacement equipment shall be done by licensed
contractors.
Valuation Fees
$0 to $1, 000.00 ......- _... -.... .$20.00
$1,000.01 to $10,000.00 ..»- ..»4.- .- $20.00 for first
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10,000.01 to $25,000.00 $155.00 for first
$10,000.00 plus $1.00 per $100.00 valuation or part thereof
Over $25,000.00 ..... $305.00 plus $0.50
per $100.00 valuation or part thereof
• Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
01/
City of Oshkosh
'g il°ofl 7:11oa5
215 ci s c ti AKA
PO Box 1130
, 7 H ��! p WI 54902 -1130
of I' othcc 920 - 236505
ON THE WNTEA Fax 920 - 236-506
•
Electric Installation Verification
(I) (We) 1- . h Electrtc-
(Electrical Contractor Name)
w sy96 _
.21 E. Orl . r ; - Ow A. (State (Zip Code}
(Address) (City)
een contracted to perform electric installation work for RcR u , Sch . __ t )
have b (Name of party co
/ boa 7 1 � � n c 3aa-�. -
at the following address: (Address where work will be performed)
The nature of the work consists of : (Check One or Describe the Nature of Work)
t Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replaccemen
Reconnection or new circuit for replacement Electric Water Heater. receptacles and
Reconnection of the Service Entrance Cable, Meter Box, alterations to
lighting fixtures
due to siding / soffit installation. Note: New Service Entrance
Cables will require a separate permit wired appliances / fixtures.
Reconnection or new circuit for other permanently
Other
The value of this work is $ /Z). ao
I 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.
S - o /
�� , 1 ‘e^ Name of Officer) (Date)
(Signature of Company Officer) (Print