HomeMy WebLinkAbout0154052 - HVAC (furnace) CITY OF OSHKOSH No 154052
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1117 VAN BUREN AVE Owner KRISTY L SCHMITZ Create Date 01/02/2013
Contractor BLACK-HAAK HEATING Category 500-Residential-Heating&Ventilating Plan
Inspector Nicole Krahn
Fuel Q Gas El Oil _1 Electric Solar LI-Solid
System ❑ New J 0 Replace ❑ Other –
H Forced Air ❑ Radiant ❑ Steam A/C Vent
❑ Electric i U Not Water ❑ Suppl. H Con. Burner
Chimney Type 0 Chimney A 0 Chimney B O Direct Vent • Not Applicable
Heat Loss O As Approved ❑ Existing • Not Applicable Value
BTU Rate As Per Plan ❑ Variable • Other Value
Use/Nature SFR/REPLACE FURANCE, ELECTRICIAN IS DIERSEN ELECTRIC "check#2952
of Work
Fees: Valuation 2 353.00 Plan Approval $0.00 Permit Fee Paid $46.00
e $ pP $
Issued By: 5)/10-
Date 01/02/2013
❑ Permit Voided Parcel Id#1605310000
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 ioOofInsp
Division of Inspection Services
P.O. Box 1 130
Oshkosh, WI 54903-1 130 _
Phone(920)236-5084 I<OfH-
Fax (920)236-5084
..^: r�F ;'.ATFR
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$100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit fee .Account Svstem and have adequate lands. check here
if you want this processed through your account (l
** Advisory-For applicable projects, an Electrical Installation Verification(Erv)form, signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
with the permit application. Applications submitted without an EICV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
DATE ia - ici -
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JOB ADDRESS I i 11 ULt-r i Ex/re r) A 't
OWNER 0,rCO Y1 1 PO I 14 C
CONTRACTOR J3Itt CV ` NCt Jc Heati
CHECK E✓1 ALL APPLICABLE
USE CATEGORY
GSingle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL Cas ['Electric ❑Solid SYSTEM ❑New ❑Replace
❑Oil ❑Solar ❑Other
TY.,
orced Air DRadiant DSteam DA/C ❑Vent DElectric DHot Water ❑Suppl. DCon. Burner
IS CHIMNEY BEING LINED lalo DYes - LINER SIZE & MANUFACTURER_
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ['Direct Vent DOther
HEAT LOSS DAs Approved ❑Existing ❑Not Applicable
BTU RATE DAs Per Plan DVariable ['Other Value (
DESCRIPTION/SCOPE OF ALL WORK BEING DONE Reetc4CP vncri C? ices( icd dui- tie
et.)
VALUE (Including labor and materials)$ 02, 353'
ELECTRICAL CONTRACTOR (for projects not requiring an ELY Form) p-(7.1 1'se \,ec he I L Li_`. •
ftrmi4 Fie 4 419 ,