HomeMy WebLinkAbout0147029-HVAC (a/c) 0 CITY OF OSHKOSH No 147029
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1830 OHIO ST Owner SHAWN A HENSLIN Create Date 07/28/2011
Contractor BLACK -HAAK HEATING Category 501 - Residential -Air Conditioning Plan
Inspector Nicole Krahn
Fuel LJ Gas LJ Oil U Electric LJ Solar LJ Solid
System ❑ New 121 Replace Other
j Forced Air j Radiant LJ Steam u A/C LJ Vent
Li Electric LJ Hot Water U Suppl. Li Con. Burner
Chimney Type 0 Chimney A O Chimney B O Direct Vent • Not Applicable
Heat Loss 0 As Approved 0 Existing • Not Applicable Value
BTU Rate 0 As Per Plan 0 Variable • Other Value
Use /Nature SFR / REPLACE A/C, EIV SIGNED BY KRUEGER ELECTRIC, INC * *check #24996
of Work
Fees: Valuation
��y $1,900.00 Plan Approval $0.00 Permit Fee Paid $38.50
Issued By: (�i 1 I Date 07/28/2011
❑ Permit Voided Parcel Id # 1407580000
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 7075 APPLETON WI 54912 - 7075 Telephone Number 920 - 757 -9990
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 Of HKOf H
ON THE WATFR
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 1 128,
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 n
** 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. �1 1001a°) DATE 01
JOB ADDRESS IWY) OhIc $t
OWNER S he vv n in
CONTRACTOR I ac K- t aq 14o
I n c
CHECK 0 ALL APPLICABLE
E CATEGORY
S ingle Family ❑Duplex ❑Multi- Family ❑Rental ❑Commercial ❑Industrial
FUEL ❑Gas � lectric ❑Solid SYSTEM ❑New Replace
❑Oil ❑ olar ❑Other
TYPE
❑Forced Air ❑Radiant ❑Steam X/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINEDNo ❑Yes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized p the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS DAs Approved ❑Existing >I<ot Applicable
BTU RATE DAs Per Plan ❑Variable ❑Other Value
DESCRIPTION / SC PE OF ALL WO 13,K DON
pep lace Cef1 1 i
o o h
VALUE (Including labor and materials) $ 1 906 • 0 CCU
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) t,Y 'r Elfciyx 1
1/3 07/07
Clry of C I 1.-ErVIC
1 1Y C'MfniA t. ern ur
PO Box 1130
z.o t kh4nsh W 1 SJP2•
UJ1 -KC/H oliv4.1u-421A -miso
0 I_ 920.2.11-]o4
Electric Installation Verification
(I) (We) �� v
(fl'4 ctrical Conn Name)
4"a_g 1,/o 14, L 1' 17- .3 `/ f ‘i/o
( Addres) (City) (State) (Zip Code)
have been contracted to perform electric ingtallauon work for ' ',1 c-
(blarne of party contractod to)
at the following address: ' %30 Q h‘ 0 St .h 1 a
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Natnrc of Work)
Reconnection or new circuit for replacement Heating Plant and%or A/C Condenser.
Reconnection or new circuit for rcplac�rnent Electric Water Heater,
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles and
lighting fixtures due to siding! soffit installation, Note: New Sctvice Entrance
Cab iCH wits require a separate permit.
Reconnection or new circuit for other permanently vrired appliances / fixtures.
Other
The value of this work is $ •
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 slid Elcoxle code
requirements,
) r f
11_ ��� W ,
(Siptaturc o Com y Offices) (Print Name of Offic - (Dat
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