HomeMy WebLinkAbout0144738-HVAC (furnace) C -.) CITY OF OSHKOSH No 144738
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1220 JEFFERSON ST Owner ROY UMICHELE K SCHUESSLER Create Date 01/25/2011
Contractor A -1 HEATING & NC INC Category 500 - Residential- Heating & Ventilating Plan
Fuel 11] Gas U Oil 1 u Electric u Solar U Solid
System fl New I n Replace ❑ Other
u Forced Air u Radiant u Steam HI NC _f Vent
Li Electric LI Hot Water U Suppl. U Con. Burner
Chimney Type 3 Chimney A 0 Chimney B O Direct Vent • Not Applicable
Heat Loss le As Approved 0 Existing 0 Not Applicable Value
BTU Rate 0 As Per Plan 0 Variable () Other Value
Use /Nature SFR / REPLACE FURNACE, EIV SIGNED BY BELL ELECTRIC * *check #10890
of Work
I
Fees: Valuation $1,650.00 Plan Approval $0.00 Permit Fee Paid $35.50
Issued By: 8Ynk Date 01/25/2011
❑ Permit Voided Parcel Id # 1506750000
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 W8078 HILLCREST CT HORTONVILLE WI 54944 - 9301 Telephone Number 920 - 779 -8838
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 R E
Division of Inspection Services C V E D
P.O. Box 1130 JAN 2 5 2011
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050 DEPARTMENT OF
Fax (920) 236 -5084 �`� _J
COMMUNITY DEVELOPMENT ' JJH <O i
INSPECTION SERVICES DIVISION .,. ,T
HVAC PERMIT APPLICATION
All information after bold categories nuist pe provided.
Incomplete applications will not be preessed.
• 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 suit 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 Verif (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performe by the homeowner) must be submitted
with the permit application. Applications submitted without an E when such is required, will not be
processed for Permit Issuance and will be returned for completion.
DATE
JOB ADDRESS I 0 (0 JP 1QrzSO & S
OWNER rn; C I Pile spu - I
CONTRACTOR A -1 Heating
RO Box 311
CHECK ® ALL APPLICABLE `` Rr111,� W154944
US CATEGORY
QSingle Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
FUEL Et6s ❑Electric ❑Solid SYSTEM ❑New IR lace
❑Oil ❑Solar ❑Other
T_Y)
�dForced Air ❑Radiant ❑Steam ❑A/C ❑Vent [Electric [Mot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED ❑No Vies - LINER SIZE 3 u & MANUFACTURER - - 4 I
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS GaAs Approved ❑Existing ❑Not Applicable
BTU RATE 111/(s Per Plan ❑Variable ❑Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE PU r
r• • • L1.4 . • Z
VALUE (Including labor and materials) $ / ( ;
ELECTRICAL CONTRACTOR (for projects not requiring an ETV Form)aX
U1 /L4 /ZU11 MUN 9:20 FAX 920 733 2713 Watters Plumbing
001 /001
• r . I. ay 9 r(13hk101 `33 .— 2,. — 7 13
0, orIn on Ser icr) /
)1$ C>tarjh Aaenuc
Pp pn+, 1 130
0011111,01 W( Win .11)0
l ! °nu, .,0.230,03° C ` 1„ , psi 420.7)0•5OK4
•
.
Electric Installation V fication
► (we) _,_.... t. Pt!‹.: r. c
(Electrical Contractor Na e)
iv • 4 I X // glen alts, i !ti ,/6 S'Y 9 S 2
( Address) (City) (State) _ (Zip Code)
h;,vc helm contracted to perform electric installation work r r _ --1 /Yea (irk) 10 % __,
Ill ` CA e. tie S met €.SS 1 ' f (Name of party contracted to)
at the following address: 1 �- �? v e4•.'erSt S J
(Address where work ill be performed)
Ile nature: of the work consists of: (Check One or Dcscrib the Nature of' Work)
,_ Reconnection or new circuit Far replacement eating Plant and /or A/C Condenser.
Reconnection or new circuit for replacement ;teethe Water Heater or power vented
water heater. •
___ _. Reconnection of the Service Entrance Cable, eter Box, alterations to receptacles
and lighting fixtures due to siccing / soffit i stallation. Note: New Service
Entrance Cables will require a separate pe 'nit.
_____ Reconnection or new circuit for the replace= t of other permanently wired
appliances 1 fixtures,
New circuit for the addition of A/C to an indiv dual dwelling unit (house or the
individual systems in a duplex or condomi ium), including required service
electrical outlets,
Other
The value of this work is $
I (hereby verify this work will be performed by an employe • of this company and further verify
the reconnection / installation will be done in compliance ith manufacturer and Electric code
I•tquircmcius.
tilt • ,t 41_ __. 1/ //1//(
..n� tiro n( C :Pinpany Offi (Print Name o Officer) (Date)
•
,oa
. i rx