HomeMy WebLinkAbout2012-HVAC (furnace) 0 CITY OF OSHKOSH No 153807
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1213 S MAIN ST Owner AMANDA B ZUEHLKE Create Date 12/04/2012
Contractor BLACK-HAAK HEATING Category 500-Residential-Heating&Ventilating Plan
Inspector Nicole Krahn
Fuel ❑✓ Gas Oil — Octric 1 Li Solar ErSolid
System ❑ New I 0 Replace Q Other
✓j Forced Air 1 ❑ Radiant i Fitteam �C Vent
U Electric 1 1 ] Hot Water 1 Elippl. 1 U Con. Burner
Chimney Type 0 Chimney A O Chimney B O Direct Vent • Not Applicable
Heat Loss As Approved O Existing • Not Applicable I Value
BTU Rate 0 As Per Plan ❑ Variable • Other i Value
Use/Nature SFR/REPLACE FURNACE, ELECTRICIAN IS DIERSEN ELECTRIC LLC "check#2803
of Work
Fees: Valuations - l$3,385.00 Plan Approval - $0.00 Permit Fee Paid - $61.00
J ' '
Issued By: 'W Date 12/04/2012
❑ Permit Voided Parcel Id#0303630000
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 (1 f I I(0��—i
Fax (920)236-5084 =N,./ATFS.
i1
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 54903-1 128. 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 volt are a contractor participating in the Permit fee .Account System and have adequate hinds. 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 ElY when such is required, will not be
processed for Permit Issuance and will be returned for completion.
Cy DATE II- ai(-la
JOB ADDRESS } IJ 3 I T t.1v VT
OWNER Rint,Yldi
CONTRACTOR Blacf - I1-cak 1--.ectfiin9) MC
CHECK Er ALL APPLICABLE
USE.CATEGORY
Angle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL CJGas ❑Electric ❑Solid SYSTEM ❑New DReplace
❑Oil ❑Solar DOther
TYFE
forced Air ❑Radiant ❑St��ea��m DA/C ❑Vent DElectric ❑Hot Water DSuppl. DCon. Burner IS CHIMNEY BEING LINED [ !o DYes - LINER SIZE & MANUFACTURER_
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE DChimney A ❑Chimney B DDirect Vent DOther
HEAT LOSS DAs Approved DExisting ❑Not Applicable
BTU RATE DAs Per Plan DVariable DOther Value
DESCRIPTION/ SCOPE OF ALL WORK BEING DONE eSiCtelff? F1.I,f'Y?GtC f rt p1aeejneri± -
2 [�U
VALUE (Including labor and materials) $ 3y 38S '
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) LACY5en Ietfri C) L C.