HomeMy WebLinkAbout0151645 - HVAC (replace AC) (-9 CITY OF OSHKOSH No 151645
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 407 E PARKWAY AVE
Owner MARGARET L MCCANN
Contractor BLACK-HAAK HEATING Create Date 08/10/2012
Category 501 -Residential-Air Conditioning Plan
Inspector John Zarate
Fuel U Gas
❑ Oil I U Electric
u Solar j U Solid
System a New I n Replace
1 I ❑ Other
❑ Forced Air u Radiant JI ❑ Steam
u A/C l u Vent I
❑ Electric _i ❑ Hot Water —1 Li Suppl.
I 11 Con. Burner I
Chimney Type O Chimney A 0 Chimney B 0 Direct Vent • Not Applicable I
Heat Loss 0 As Approved
Existing • Not Applicable I Value
BTU Rate p As Per Plan
Variable • Other I Value
Use/Nature SFR/REPLACE A/C, EIV SIGNED BY KRUEGER ELECTRIC **check#2173
of Work
Fees: Valuation $475.17 Plan Approval
$0.00 Permit Fee Paid $25.00
Issued By: . 5}'Y)
11 Date 08/10/2012
❑ Permit Voided I Parcel Id#0404460000
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.
R I'lly
('ity of Oshkosh
Division of Inspection Services
P.O. Box 1 130
Oshkosh, WI 54903-1 130
Phone(920)236-5050
Fax (920)236-5084 Of 100 O
ON T-{- .,.ATFR
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 54903-1 128. 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 von are a contractor participating in the Permit fee Account System and have adequate bilitds. 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.
r, DATE 3" �7- (9-6
) o�
JOB ADDRESS 4-}0'? E PcctYk ltk�lh A Ile.
OWNER I i t0.Y ClYQ 'mc.(a.nn J�
CONTRACTOR Black- I4c c k -Eric
CHECK 0 ALL APPLICABLE
USE CATEGORY
®'Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL ❑Gas CElectric ❑Solid SYSTEM ❑New ❑Replace
❑Oil ❑Solar ❑Other
TYPE
❑Forced Air DRadiant ❑Steeamm fg</C ❑Vent DElectric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED 1E41< ❑Yes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B DDirect Vent ❑Other
HEAT LOSS DAs Approved ❑Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable ❑Other Value
DESCRIPTION / SCOPE OF ALL WORK BEING DONE ?ef2 lac e rri 11+ tik- v r't.LYjki-iCP1ir
VALUE (Including labor and materials) $ /�!5 • ��
ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) WYE(€Q.CY ke-fr 1 c_
;,
Clry of Ceinkarn
Nvivege rtf Ins etwn
211 0Itith nv=n,-,c
PO Box 10(1
r*hkruh WI S- 01,1110
011—KtAIH a»ulA_t,lso
1)1+1.4+,, FIR 520-21i■-1014
Electric Installation Verification•
(I (we) t'� l i ��
. -,.'S �_�.
( ctrical Contractor Name)
Yi 1 Vex n Ace,L(`-o Imo- )„) L-1 H7 c_ CL,,_?1- . C-/ 7E_
(Address) (Ciry) QQ (State) (Zip Code)
have been contracted to perform electric installation work for vIack- iteti
(bTame of party conmactot'to)
at the following addre3s: _ 0-}O1 e )(41)(_,
(Address where work will be performed)
The nature of the work consists of: (Check One or Deecribn the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and or &IC Condenser.
Reconne-etion or new circuit for rcpIacernent El+~ctric Water Heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles and
lighting fixtures due to siding! soffit installation, Note: New $c"ryice Entrance
Cables will require a separate permit.
Reconnection or new circuit for other permanently vrired appliances / fixtures.
Other
no
The value of this work is S, c,
I hereby verify this work will be performed by an employee of this company and further verity the
reconnection 1 installation will be done in compliance with manufacturer and Eiccwi c code
requirements.
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i a c of"Com- �y Officer) (J}nnt Name of Office ---
ffic (Date)
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