HomeMy WebLinkAbout0100952-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
.lob Address 1219 WESTERN ST
Contractor RASMUSSEN'S HEATING & A/C INC
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner GARY A MALKOWSKY
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type ]~ ChimneyA O Chimney B
Heat Loss ]~ As Approved O Existing
BTU Rate ]~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
100952
04/23/2003
Other J
Vent J
80,000
Use/Nature SFR/Replace furnace & A/C* EIV from Slims Electric attached.
of Work
Fees: Valuation
Issued By:
$4,860.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$78.50
Date 04/23/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number
920-235-6569
City'of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, ~ 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
OZHKO
OKI 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 great~.
OR
If you are a contractor part,icipating in the Permit f¢¢ ~ccount System and.have adequate_funds, checl~ here
if ¥ozt. want this processed through your account ~
· o~ nDDaESS ,/,~ i ~ '~0
CONTRACTO~ . ~a,~ mo -~.~ ¢'"' ::,
APPLICABLE
S.S.mCATEGORY
glo Family ODuplcx I-IMulfi-Family I"iRental
ClCommercial
I-lIndustriaI
FUEL I~s ElElectric OSolid SYSTEM E/New i~eplace
r'lOil I-ISolar rlOtb..er
~o'rcedAir ORadiant EISteam ~C E]Vent
IS ~ BEING I.INED ~o OYes - ~ $~
l~lO~e: A]~ chimneys shall be sized per the BTU~s be/ng ve~ted.
CHIMNEY TYPE OChinmey A ~'mmey B
HI~.AT LOSS [NAs Approved [H~/sting
BTU RATE OAs Per Plan EWar/able
r'iElectric EIHot Water OSuppl. CICon. Burner
& MANUFACTWRER
ODirect Vent OOther
ONot Applicable
~Othervalue ~,*~
VALUE (Including labor and nH materials ineluding light fixtures) $ q~tg. ~
,. ~. ~ .,?~ 3~
,Ii,For applicable projects, an Ele~tri~ Installation Verifi~on form, signed by the Eleetrical Contractor, must be
attached. If not attached or not applicable, a ~parate Electrical Permit is requin~
Electric Instellatioa Verification
(A4m~) (Ci~) (S~) (Zi~ Co~)
The nature ofthe work consists oP. (.Check One or Descn~oe the Nature o£Wmk)
The value of'tMs wo~ is $,,