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Home My WebLink About0095251-HVAC (a/c) L CITY OF OSHKOSH No 95251 OSHKOSH HVAC PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 2635 MONTCLAIR PL Owner KARL J SCHULTZ Create Date 06/19/2002 Contractor RASMUSSEN'S HEATING & A/C INC Category 501 - Residential -Air Conditioning Plan Fuel l✓ Gas 1 Oil ] Electric 1 Solar 1 1 Solid System [] New 0 Replace [] Other Ls/ Forced Air J Radiant u Steam u A/C Li Vent Electric 1 Hot Water 1 Suppl. Con. Bumer Chimney Type 0 Chimney A • Chimney B O Direct Vent 0 Not Applicable Heat Loss ( ) As Approved • Existing 0 Not Applicable Value 0 BTU Rate 0 As Per Plan O Variable • Other Value 2.5 ton Use /Nature SFR/ Replace a/c unit. *EIV form from Slim's Electric. of Work Fees: Valuation $2,112.00 Plan Approval $0.00 Permit Fee Paid $38.00 Issued By: K11iV\ Date 06/19/2002 ❑ 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 City oOofsh Division si In on of Inspections Services P.O. Box 1130 Oshkosh, WI 54903 -1130 Phone (920) 236 -5050 Fax (920) 236 -5084 ON W W ER HVAC PERMIT APPLICATION 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 PermicfreA_ccount System and have adequate funds. check here if you want this processed through your account fl DATE 4 - (1- JOB ADDRESS 26 3 5 /V_evtt c(o.: r OWNER (&r( SGh + z CONTRACTOR RQSmvSSCA s I -IVAC. CHECK H ALL APPLICABLE USE CATEGORY [Single Family ❑Duplex ❑Multi Family ❑Rental ❑Commercial ❑Industrial FUELlGas ❑Electric ❑Solid SYSTEM ❑New ❑Replace ❑Oil ❑Solar OOther TYPE Ii3Forced Air ❑Radiant OSteam 0A/C OVent ❑Electric [Mot Water OSuppl.CDCon. Burner IS CHIMNEY BEING LINED KNo ❑Yes - LINER SIZE & MANUFACTURER Note: All chimneys shall be sized per the BTU's being vented. CHIMNEY TYPE OChimney A PSChimney B ODirect Vent ❑Other HEAT LOSS OAs Approved inxisting Mot Applicable „ BTU RATE ❑As Per Plan OVariable JaOther Value a a 'TO DESCRIPTION OF ALL WORK BEING DONE , R c IO�a L i n f J A/ u v i d' VALUE (Including labor and all materials including light fixtures) $ 1 1 ELECTRICAL CONTRACTOR OR XElectric Installation Verification form attached(if Replacement) • Electrical installation of new/replacement equipment shall be done by licensed contract< gat ofO ahtosh Divtt of htipeolioo Services 215 Chrea Mom PO Hox 1130 Oshkosh WI 54903 -1130 071;0{17 re 920 - 236 -5050 r Fax 920'236 -5064 Electric Installation verification I(We) 5(iw,' E1ec'r' -- (Electrical Contractor Name) ADS OCISA Uo6C Cr , OSh kos in w 1 6 (Address) (City) (State) (Zip Code) have been contracted to perform electric installation work for Ras muss c.7 3 H VA , (Name of party contracted to) at the following address: ,R635 /4 o nfc( r (Address where work will be performed) The nature of the work consists of: (Check One or Describe the Nature of Work) X Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser. Reconnection or new circuit for replacement Electric Water Heater or power vented 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 Cables will require a separate permit. Reconnection or new circuit for the replacement of other permanently wired appliances / fixtures. New circuit for the addition of A/C to an individual dwelling unit (house or the individual systems in a duplex or condominium), including required service electrical outlets. Other The value of this work is $ /$A tb . 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. Alle, I ` 1' 1)1 6 - /9 -der (Signature of Co .1 ' i cer) (Print Name of Of ffcer) (Date)