HomeMy WebLinkAbout0100958 HOSHKOSH
ON THE WATER
.lob Address 1275 PHEASANT CREEK DR
Contractor BERLIN HEATING & COOLING
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 RUSCH HOMES
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved ~ Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
100958
03/06/2003
Other J
Vent J
Use/Nature NSFR/Heating & ductwork, vent bath fans, vent range, gas piping, furnace vent.
of Work
Fees: Valuation
Issued By:
$3,800.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$62.00
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 N7545 Forest Ridge Rd BERLIN WI 54923 -0
Telephone Number
920-361-3066
~ity of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-$084
O/HKO/H
ON TH~ 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 ~]
sos mDm SS
OW R
CONTRACTOR
CHECK [] ALL APPLICABLE
U~E CATEGORY
~Single Family F1Duplex V1Multi-Family
FUEL ~Gas []Electric [:]Solid
[]Oil F1Solar
~oorEced Air F1Radiant VISteam V1A/C []Vent
IS CHIMNEY BEING LINED VINo [=lYes - LINER SIZE
Note: All chimeys shall be sized per the BTU's being vented.
CHIMNEY TYPE
HEAT LOSS
BTU RATE
[]Chimney A
[]As Approved
[]As Per Plan
[]Chimney B
[]Existing -
[]Variable
VIRental
SYSTEM
VICommercial Vllndustrial
~ew []Replace
[]Other
[]Electric []Hot Water []Suppl. []Con. Burner
& MANUFACTURER
DESCRIPTION OF ALL WORK BEING DONE
~Direct Vent
[]Not Applicable
[]Other Value
VIOther
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02