HomeMy WebLinkAbout0151329 - HVAC (replace Furnace) 0 CITY OF OSHKOSH No 151329
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1641 S OAKWOOD RD Owner SEAN P/KRISTINE WALSH Create Date 07/23/2012
Contractor BLACK-HAAK HEATING Category 500-Residential-Heating&Ventilating Plan
Inspector Nicole Krahn
Fuel I✓I Gas 1 1 Oil ] n Electric Li Solar Solid
System E New I n Replace I f] Other 1
J Forced Air u Radiant u Steam Li A/C Vent
L Electric Li Hot Water 7 I I Suppl. Li Con. Burner
Chimney Type C Chimney A O Chimney B O Direct Vent • Not Applicable
Heat Loss O As Approved O Existing 0 Not Applicable Value
BTU Rate 0 As Per Plan O Variable • Other Value
Use/Nature SFR/REPLACE FURNACE,EIV SIGNED BY KRUEGER ELECTRIC **check#2048
of Work
Fees: Valuation $840.00
/ $840.00 Plan Approval $0.00 Permit Fee Paid $25.00
Issued By: ?51 J I k Date 07/23/2012
El Permit Voided Parcel Id#1331350000
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 54903-1 130
Phone(920)236-5050 ��I I���I j
Fax (920)236-5084 1
.. r:-IF
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.
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 'I-Irl' �a
JOB ADDRESS 1641 5 Oak. ocock
ka
OWNER" C y f "t r L )Cd
CONTRACTOR Black - f466a4_ H ea:til l , I:47c •
CHECK 10 ALL APPLICABLE
USFt.EATEGORY
mgle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL PfGas ❑Electric ❑Solid SYSTEM ❑New Eieplace
❑Oil ESolar DOther
TYj?E
orced Air ❑Radiant ❑Steam ❑A/C ❑Vent DElectric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED CN Io DYes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent DOther
HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable DOther Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE
ee pI acemir?+ oc lets - u vna
VALUE(Including labor and materials) $ 3' O. 00
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) ►rr Qer 1 C "
�J
07/07
City of C^sn In r
446-16—:114:/) 211 Chuti,h I,cnu
PO Bow 1129
C).11--KCIH (T hknch WI SJ4C2,117L'
CN11r��47U-371a<�I}0
ac ln6+'l.n i ' 920-23f-3044
Electric Instillation Verification
(L'-lctricel Contractor Name)
I Y O ( V C$ ..c*C Cf,�lam.r o C" I� �,d� Li'
I' ;' `f
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for 3:10.0- f{ctaic N C.
(r,Nanne of party contracted u)
at the following address: - 164\ S Oakwood kck
(Address where work will be performed)
The nsturc 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.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles and
lighting fixtures due to sidingi soffit instsllation, Note: New Service Entrance
Calilcn will require a separate permit,
Reconnection or new circuit for other permane=ntly wired appliances / fix lures.
_ Other
The value of this work is $ b („'
T
hereby verify this work will he performed by an employee of this company and Bather vcl'ify the
reconnection/ installation will be done in compliance with manufacturer and Electra:code
requirements.
f �/f ''JJ 1
`ref 41a � fc� l) . � �� -� � 1=r1?'1a
(Sipnaturc o Compiny Officer) (Print Name of Ofhc r (Date)
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