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HomeMy WebLinkAbout0152556 - HVAC (replace AC) I CITY OF OSHKOSH No 152556 OSHKOSH HVAC PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 2525 VILLAGE LN Owner ROBERT J/MONICA M PENZENSTADLER Create Date 09/25/2012 Contractor BLACK-HAAK HEATING Category 501 -Residential-Air Conditioning Plan Inspector Nicole Krahn Fuel Ilas J FT—Oil ❑ Electric J ❑ Solar 1 ❑ Solid System ❑ New J ❑ Replace J ❑ Other 1 Fir Forced Air J ET,4diant Steam _I NC ❑ Vent 1 ❑ Electric E Hot Water ❑ Suppl. ❑ Con. Burner Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent • Not Applicable J Heat Loss As Approved 0 Existing 0 Not Applicable ] Value BTU Rate -- - Q As Per Plan 0 Variable • Other Value Use/Nature SFR/REPLACE A/C, EIV SIGNED BY KRUEGER ELECTRIC **check#2400 of Work II J Fees: Valuation $4,000.00 Plan Approval $0.00 Permit Fee Paid $70.00 Issued By: Thfiltpi Date 09/25/2012 ❑ Permit Voided ' Parcel Id#1321210000 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 oOfI Division of of Inspection Services P.O. Box 1130 Oshkosh, WI 54903-1130 Phone(200)236-5050 O JHKO JH Fax x (920)236-5-5084 ON 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 yon 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. DATE aka ?-f8- is JOB ADDRESS .A5 9,5 ul Ilale rt OWNER Qik& fi Monica. Pelrvos+aci Ley CONTRACTOR_ ,e)10.4k- Hcia..l<. He&-h09,--MC • CHECK EI ALL APPLICABLE USE CATEGORY E Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial FUEL R6-as ❑Electric ❑Solid SYSTEM ❑New ❑Replace ❑Oil ❑Solar ❑Other TYP orced Air ❑Radiant ❑Steam ❑A/C EVent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner IS CHIMNEY BEING LINED L5<o ❑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 ❑As Approved ❑Existing ❑Not Applicable BTU RATE ❑As Per Plan ❑Variable ❑Other Value ``'� tp DESCRIPTION/SCOPE OF ALL WORK BEING DONE kesicten- Kc-1 �Q� *Lae etrnp. i-- VALUE (Including labor and materials) $ ()[1©..no ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) ed,(Q � ✓✓ 07/07 Cry vi CZnrnul N.,iwyn rri)1IF 11.ra-cm.ir:•7z 217 CRIA. 1 r.K,,■,c POB Ok13i(I tkhk`xh WI$-4 t2-II)C 0. I-I /H Unka il1+Ct11}0 W+T^6 4411■■ Fix 920-2.1y..]On4 Electric Installation Verification (1) (We) mo (Z. ( ctrical Contractor Name) rr I if° 1 Gr cp cQ rt r o �� /�� ) L I f�-l7 E (_lam�i L L `L- 5 / Y C� (Addre;.,$) (City) (State) (Zip Code) have been contracted to perform electric inntallauon work for BIack /4aa:k Ile nq (Name of party contract to) at the following address: _ a595 VII/Rae k- n (Ad ess where work will be performed) The nature of the work consists of; (Check One or Describe the Nature of Work) XReconnection 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 pox, alterations to receptacles and lighting fixtures due to siding./ soffit installation, Note; New Soryice Entrance Cablca will require a separate permit. Reconnection or new circuit for other permanently wired appliances f fixtures. Other The value of this work is S a57)=°' I hereby verify this work will he performed by an employee of this company and farther verify the reconnection/ installation will be done in compliancc with manufacturer and Electric code requ irern ents, 6.) r ,f 1_ \-,-) q-1g- (5i P�afore 0 Compiny affic cr) (Print Name of Ofdeeh- (Date) Eft ?e'/d Z666LnLLIrc rrn:er EOW:,/;T.'°,t;