HomeMy WebLinkAbout0144731-HVAC (furnace) l CITY OF OSHKOSH No 144731
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2117 JEFFERSON ST Owner KATHLEEN L TEICHMILLER Create Date 01/24/2011
Contractor BLACK -HAAK HEATING Category 500 - Residential- Heating & Ventilating Plan
Fuel ✓f Gas [J Oil 1 Electric Li Solar ❑ Solid
System ❑ New Q Replace n Other
U Forced Air u Radiant ] Steam J A/C U Vent
[J Electric Li Hot Water L j Suppl. Li Con. Burner
Chimney Type J Chimney A () Chimney B 0 ) Direct Vent • Not Applicable
Heat Loss rp As Approved • Existing 0 Not Applicable Value
BTU Rate () As Per Plan () 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: ajyy...J Date 01/24/2011
❑ Permit Voided Parcel Id # 1515750000
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 OJHKO.'H
ON THE WATER
,�{� /}���' �C 't✓ � Di AII HVAC o PERMaT a AP r PLICATpON ed.
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.
DATE 011 1 ( I
JOB ADDRESS ■ t I " I1 l4 f t .) o f l Ko r,
OWNER KIU RECEIVED
CONTRACTOR V I( /I'1 h4 G� U1(
JAN 2 4 2011
DEPAR f OF
CHECK Ed ALL APPLICABLE COMMUNITY DEVELOPMENT
USE CATEGORY INSPECTION SERVICES DIVISION
OISingle Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
FUEL 1 Gas DElectric ❑Solid SYSTEM ❑New I (Replace
❑Oil ❑Solar ❑Other
TYPE
L (Forced Air DRadiant ['Steam DA /C ❑Vent DElectric DHot Water ❑Suppl. DCon. Burner
IS CHIMNEY BEING LINED CjilNo DYes - 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 t4Existing DNot Applicable
BTU RATE DAs Per Plan ❑Variable 00ther Value � `
DESCRIPTION / SCOPE OF ALL WORK BEING DONE `Rec )O[( nacL
VALUE (Including labor and materials) $ 9\00 D , OD
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) - Kil./tetjP,( 'C IL
07/07
Nvisiaei ni Iruryena. i�vvx r..
2 1, trn.
f1U
l hgkeuh WI S -1001- 11 .10
art +011 unl,•� +1u- a1A -P1}0
CH =WV p. .42 -2 -]0114
Electric Installation Verification
(1) (We) K r
(
�/� l- ctrical Contractor Name)
�/' / � J �y
I
Vol l Vex r� Gi ftM -O Cr I� k L.1 �� e_ Cite J — .� / ( et V
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for B !OK 4'1
(Narnc of p etor
at the following addro s: )1 11 St-ff- 'SD V1 S7-. I O Kosig
(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 AJC Condenser.
Reconnection or new circuit for replacement Electric Water Neater,
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles and
lighting fixtures due to siding! soffit installation, Note; New Scryice Entrance
Cal will require a separate permit.
Reconnection or new circuit for other permanently wired appliances / fixtures.
Other
The value of this work is $ i5o,o/
. 1 hereby verify this work will be performed by an employee of this company and further verify the
reconnection/ installation will be done in complinn.co with ma.nufaeturer and Elect code
requirements.
//
i c f om c) (Print Name of Offic Date
(5 pzlatur. o C y Officer) tT'nn (Date)
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