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Home My WebLink About0146602-HVAC (furnace & a/c) CD CITY OF OSHKOSH No 146602 OSHKOSH HVAC PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 633 GROVE ST Owner JENNIFER J DUTKO Create Date 06/29/2011 Contractor MCM AIR INC Category 502 - Residential -Both Plan Inspector John Zarate Fuel u Gas U Oil U Electric Solar Li Solid System ❑ New 1 121 Replace 1 ❑ Other u Forced Air u Radiant Steam u NC u Vent H Electric u Hot Water U Suppl. H Con. Burner Chimney Type 0 Chimney A 0 Chimney B • Direct Vent 0 Not Applicable Heat Loss 0 As Approved 0 Existing 0 Not Applicable Value BTU Rate 0 As Per Plan 0 Variable • Other Value Use /Nature SFR / Replace furnace and a /c. EIV signed by Seckar Electric. of Work Fees: Valuation $6,000.00 Plan Approval $0.00 Permit Fee Paid $100.00 Issued By: a /A-2 Date 06/29/2011 ❑ Permit Voided Parcel Id # 1103860000 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 6122 COUNTY ROAD M WINNECONNE WI 54986 - 9780 Telephone Number 920 - 582 -4402 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 /DO 4 P.O. Box 1130 I Oshkosh, WI 54903 -1130 Phone (920) 236 -5050 Fax (920) 236 -5084 OJHKOIH 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 Permitjee 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 (o `c78 ' f/ JOB ADDRESS 633 6' rO t it° st OWNER Jennifer- jib -k- RECEIVED f MCM AIR INC. JUN 2 9 2011 CONTRACTOR 6122 County Rd M Winneconne, WI COMMUNITY OF CHECK H ALL APPLICABLE 1 54986 UNITY DEVELOPMENT 4.1 5 •SE4/O INSPECTION SERVICES DIVISION USX CATEGORY -Single Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial FUEL fdGas DElectric ❑Solid SYSTEM ❑New 21(eplace ❑Oil ['Solar ❑Other TYPE ['Forced Air [Radiant ❑Steam ❑A/C , lent DElectric ❑Hot Water ❑Suppl. DCon. Burner IS CHIMNEY BEING LINED 6o DYes - LINER SIZE & MANUFACTURER Note: All chimneys shall be sized per the BTU's being vented. CHIMNEY TYPE ❑Chimney A ❑Chimney B ia'birect Vent ❑Other HEAT LOSS DAs Approved ❑Existing ❑Not Applicable BTU RATE DAs Per Plan DVariable DOther Value /�j DESCRIPTION / SCOPE OF ALL WORK BEING DONE �./ 2/06 Fa/zM.. /�C : awl � L 5 u v/; E0000 A771 , 7 7 07,5 ron AC VALUE (Including labor and materials) $ <D 660 , ov ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) 07/07 curor cd�r .n gar allna c a savia 215 Ch iueh Meaoa POBac 1110 Odc1cod►W1 54903 -1130 iTV.( O 9250- X6.5050 . —,, Fac 920- 236 -3014 Electric Installation Verification 1 (We) SekT -le ALE t L (Electrical Contractor Name or Homeowner's Name) 1Zo COJW01/ Pcrum 2, ler . 040‘ (4), S (Address) (City) (State) (Zip Code) accept the responsibility to perform the electric work as stated below, at the following address: 4033 Glove 5f. • (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, 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 REC=IVEL) JUN 2 9 2011 DEPARTMENT OF The value of this work is $ I Ca 0 .OD . COMMUNITY DEVELOPMENT INSPECTION SERVICES DIVISION 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. 1 * , , ' (/ (. p 1J c 1 1* +e. Sger lti,. [Q . a' I l (Siguathre d . mpaw Mica or Homeowner) (Print Name) (Date)