HomeMy WebLinkAbout2011-HVAC (exhaust in storage room) / CITY OF OSHKOSH No 147006
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 4200 POBEREZNY RD Owner GRS LLC Create Date 07/27/2011
Contractor QUALITY MECHANICAL INC Category 512 - Ind. & Comm -Both Plan N6- 3112 -0810H
Inspector Brian Noe
Fuel L J Gas L Oil Li Electric Li Solar J Solid
System O New El Replace n Other
Li Forced Air u Radiant u Steam U A/C u Vent
Li Electric L Hot Water Ll Suppl. Li Con. Burner
Chimney Type 0 Chimney A O Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved O Existing • Not Applicable Value
BTU Rate 0 As Per Plan O Variable • Other Value
Use /Nature COMM / INSTALL EXHAUST IN STORAGE ROOM PER STATE APPROVED PLANS (TRANSACTION ID #1944526 - SITE ID
of Work #758761) * *check #7318
Fees: Valuation $4,335.00 Plan Approval $0.00 Permit Fee Paid $76.00
Issued By: Date 07/27/2011
El Permit Voided Parcel Id # 1324250000
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 PO BOX 162 LITTLE CHUTE WI 54140 - 162 Telephone Number (920) 687 -1299
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
Fax (920) 236 -5084 •
z yA -
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 vour account f
** Advisory - For • • plicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical
Contractor or Ho I, eowner (for installations allowed to be performed by the homeowner) must be submitted
with the permit a • • lication. Applications submitted without an EIV when such is required, will not be
processed for Pe • 1 't Issuance and will be returned for completion. M �``
•
DATE 1 Jl 2/J f
JOB ADDRESS ) / 7_ (2
14
OWNER G Y` L�-�. l fin, UQ.U2.t,C}x /4)A) 1 / - D 3JD
_ � �_ ! �. ... . , . �
N C 1'1
CONTRACTOR _
CHECK ® ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi - Family ❑Rental $Commercial ❑Industrial
FUEL ❑Gas DElectric ❑Solid SYSTEM ❑New ❑Replace
DOH ❑Solar g1Other FAncw. �
TYPE
❑Forced Air ❑Radiant El Steam ❑A /C ❑Vent DElectric ❑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 DExisting [Not Applicable
BTU RATE DAs Per Plan DVariable ❑Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE _ 4 , A : _ , , _r AA �_ _ A—
L A AAA (2 CT Crre57►n, i)
VALUE (Including labor and materials) $ 1 '} J j . 00
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form)
VI Co 07/07