HomeMy WebLinkAbout0153767 - HVAC (furnace) CITY OF OSHKOSH No 153767
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1040 N WESTFIELD ST Owner EVERGREEN VILLAGE Create Date 11/29/2012
Contractor MCM AIR INC Category 510-Ind.&Comm-Heating&Ventilating Plan
Inspector Nicole Krahn
Fuel ✓ Gas Oil Electric H Solar Solid
System ❑ New 0 Replace ❑ Other
0 Forced Air Radiant 1 ❑ Steam 1 ❑ A/C 1 ❑ Vent 1
U Electric 1 ❑ Hot Water LJ Suppl. LJ Con. Burner
Chimney Type 0 Chimney A ❑ Chimney B • Direct Vent ❑ Not Applicable
Heat Loss As Approved 0 Existing • Not Applicable Value
BTU Rate ❑ As Per Plan ❑ Variable • Other Value
Use/Nature OMM(APT#312)/REPLACE FURANCE,ELECTRICIAN IS SECKAR ELECTRIC **check#23358
of Work
Fees: Valuation $3,000.00 Plan Approval $0.00 Permit Fee Paid $55.00
Issued By: 2fry)LA Date 11/29/2012
❑ Permit Voided Parcel Id#1608640200
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 6122 COUNTY ROAD M WINNECONNE WI 54986 -9780 Telephone Number 920-582-4402
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
Oshkosh,WI WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 OJHKOJH
ON THE WATER
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 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 //' 7
JOB ADDRESS /U c // L�� f'/e/fix f;
OWNER PTi rz
CONTRACTOR 4Z)it) //p1 /j) 7
CHECK 171 ALL APPLICABLE
USE CATEGORY
12Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL ErGas ❑Electric ❑Solid SYSTEM ❑New Replace
❑Oil ❑Solar ❑Other
TYPE
BForced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. DCon. Burner
IS CHIMNEY BEING LINED EiNo ❑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 i'? //Vd -, 7)1 )2
/(r--r,r7 .gTPS Cod 0 / 7-Ca S
VALUE (Including labor and materials) $ 366 C
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
•
07/07