HomeMy WebLinkAbout0145216-HVAC 0 CITY OF OSHKOSH No 145216
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 855 W 12TH AVE Owner SCOTT J SIEWERT Create Date 02/16/2011
Contractor CUSTOM HEATING & COOLING Category 500 - Residential- Heating & Ventilating Plan
Fuel U Gas HI Oil u Electric 0 Solar U Solid 1
System L New ❑ Replace 1 Li Other
Li] Forced Air u Radiant u Steam u NC Vent
U Electric Li Hot Water J Suppl. U Con. Burner
Chimney Type ( ) Chimney A 0 Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved n Existing • Not Applicable Value
BTU Rate As Per Plan 0 Variable • Other Value
Use /Nature SFR/ Interior Remodel *adding (3) heat vents and (2) cold returns to upstairs remodel
of Work
Fees: Valuation $350.00 Plan Approval $0.00 Permit Fee Paid $25.00
Issued By: Date 03/22/2011
0 Permit Voided Parcel Id # 1306270000
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 approval efore starting such activity.
Signature G `_ „..� Date "3/27/ r
Agent/Owner
Address 1503 S MAIN ST OSHKOSH WI 54902 -6911 Telephone Number (920) 235 -7263
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 -.1.111141
Oshkosh, WI WI 54903-1130
54903 -1130
Phone (920) 236 -5050
Fax (920) 236 -5084 Of HKOJH
ON THE WATER
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 Permit fee Account System and have adequate funds, check here
if you want this processed through your account (l
** 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 2 2—/
JOB ADDRESS '7•5 1.1./ 1 11- /t1 v c
OWNER Sc:e0 S w , eV- T
CONTRACTOR "'s) 4 i I
CHECK 10 ALL APPLICABLE
U E CATEGORY
Single Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
FUEL Gas ❑Electric ❑Solid SYSTEM ❑New ❑Replace
❑Oil ❑Solar ❑Other
TyPE
orced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED ❑No ❑Yes - 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 ❑Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable ❑Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE
Luc- y r ''' (.. ✓rC 14 c -u F v e--L i S c4 t &eve
Cv1 c- R # �} c— Go ✓ 4-, S i c,
VALUE (Including labor and materials) $ 5
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
07/07