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Home My WebLink About0146354-HVAC (furnace) 0 CITY OF OSHKOSH No 146354 OSHKOSH HVAC PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 2107 JEFFERSON ST Owner JOHN SAMIDA JR Create Date 06/14/2011 Contractor BETTER HOME HEATING & AIR CONDII Category 500 - Residential- Heating & Ventilating Plan Inspector John Zarate Fuel [✓j Gas Li Oil u Electric Li Solar J Solid System ❑ New I 0 Replace ❑ Other u Forced Air Li Radiant J Steam Li A/C HI Vent Li Electric U Hot Water I Suppl. U Con. Burner Chimney Type 0 Chimney A O Chimney B 0 Direct Vent • Not Applicable Heat Loss p As Approved O Existing • Not Applicable Value BTU Rate p As Per Plan O Variable • Other Value 60,000 Use /Nature SFR / REPLACE FURNACE, EIV SIGNED BY KOLLMANN ELECTRIC * *check #67989 of Work Fees: Valuati $1,667.00 Plan Approval $0.00 Permit Fee Paid $35.50 Issued By: Date 06/14/2011 ❑ Permit Voided Parcel Id # 1515770000 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 1054 AMERICAN DR NEENAH WI 54956 -1305 Telephone Number 920 - 733 -2161 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 O.lHK01H Fax (920) 236-5084 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 fl ** 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 to — Ib - 11 JOB ADDRESS a 10 7 OWNER -, c . CONTRACTOR g► • A _,.111■ .. Ia.. i ,,. CHECK Et ALL APPLICABLE US CATEGORY ❑" Ingle Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial FUEL Dias DElectric ❑Solid SYSTEM ❑New DReplace DOil ❑Solar DOther ' Weed orced Air ❑Radiant El Steam DA/C ❑Vent DElectric DHot 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 DDirect Vent DOther HEAT LOSS DAs Approved DExisting ❑Not Applicable BTU RATE DAs Per Plan DVariable DOther Value DESCRIPTION / SCOPE OF ALL WORK BEING DONE ( 0 0 d VALUE (Including labor and materials) $ I ( O - 00 ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) VC 1 Md V) - ?7o 9 07/07 06/13/2011 08:19 9202737965 KOLLMANN ELECTRIC PAGE 01/03 (4-.1111,-.) 215 Division 0f 1032e e Services 21 S Church Avenue PO Box 1130 Oshkosh WI 54903 -1130 Office 920.256 -5030 o Pax 920. 2365084 Electric Installation Verification I (We) X14L. 4 7441 ; - i s L L G (Electrical Contractor Name or Homeowner's Name) PO / x 2 4 1 / , c, 7 w � r (Address) (City) (State) (Zip Code) accept the responsibility to perform the electric work as stated below, at the following address: �/; /0 7 %7.50,7 SI (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 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, including required service electrical outlets. Note: Homeowners can only do their own electric on a single family owner occupied home. Work on a condominium, duplex, rental, or multi -use building would require a licensed Electrical Contractor. Other ��rV The value of this work is $ . I hereby verify this work will be performed in compliance with the License requirements of Section 11 -22 of the Oshkosh Municipal code and further verify the reconnection / installation will be done in compliance with manufacturer and Electric code requirements. .....- ,17eerviir It14-ate „., A... 6:41-?„4% " ;gnat Hof Company Officer or Homeowner) (Print Name) (Date) 01/07 Received Time Jun. 13. 2011 9:12PM No. 6015