HomeMy WebLinkAbout0153960 - HVAC (furnace) CITY OF OSHKOSH No 153960
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3925 SUMMERVIEW DR Owner RONALD L/C C FEUTZ Create Date 12/17/2012
Contractor BLACK-HAAK HEATING Category 500-Residential-Heating&Ventilating Plan
Inspector John Zarate
Fuel U Gas ❑Oil U Electric J ❑ Solar Solid
System ❑ New _ ❑✓ Replace ❑ Other
Forced Air r] Radiant 'I Steam A/C I � Vent
Li Electric ❑ Hot Water Li Q Suppl. L Con. Burner
Chimney Type 0 Chimney A O Chimney B E Direct Vent • Not Applicable
Heat Loss As Approved 0 Existing • Not Applicable Value
BTU Rate 0 As Per Plan 0 Variable • Other Value 70,000
Use/Nature SFR/REPLACE FURNACE, ELECTRICIAN IS DIERSEN ELECTRIC .*check#2907
of Work
Fees: Valuat ion --_ — -- — -. - - - -
$3,284.00 Plan Approval $0.00 Permit Fee Paid $59.50
Issued By: 5 " Date 12/17/2012
❑ Permit Voided) Parcel Id#1528530000
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 01-Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-I l 30
Phone(920)236-5050 ��I I\O�I-�
Fax (920)236-5084
ON tH ',O'TFR
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 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 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.
C DATE low` 13 I.
JOB ADDRESS (31"/c 5 &t n me r U i ec.�-> DY
OWNER ioti Fe LL
CONTRACTOR t)iate.16- trctCL{C Pe�itl'ir , �i• _- •
CHECK Q ALL APPLICABLE
USX,CATEGORY
lrrS Ingle Family ❑Duplex ❑Multi-Family ❑Rental DCommercial ❑L clustrial
FUEL G:"Gas DElectric DSolid SYSTEM :New alk<Eace
ElOil ❑Solar ❑Other
T
forced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppi. ❑Con. Burner
IS CHIMNEY BEING LINED B'No/❑Yes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE DChimney A ['Chimney B ❑Direct Vent ❑Other
HEAT LOSS DAs Approved ❑Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable DOther Value
DESCRIPTION /SCOPE OF ALL WORK BEING DONE le,sickvifica ra, Iavenery± Lu'/
CiS 9D r£i 'IOC L37-4 flat. c ja S
VALUE(Including labor and materials) $73)
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) DI eYscrl �'J +�1 U, LC '
ca rp'0- L/8"7S
er m+-t Fee 5q,