HomeMy WebLinkAbout0154193 - HVAC (replace boiler) ell) CITY OF OSHKOSH No 154193
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 417 W 11TH AVE Owner DEAN R DUEHRING/CARRIE KOSEK Create Date 01/17/2013
Contractor MCM AIR INC Category 500-Residential-Heating&Ventilating Plan -_
Inspector Nicole Krahn -
Fuel 0 Gas [jai ' ❑ Electric I EIFS(lar [Solid 1
System ❑ New _ ❑✓ Replace I ❑ Other
Forced Air Radiant 0 Steam I El A/C 1 Elint
Li_ tric 7 Hot Water ❑ Suppl. j Li Con. Burner ,
Chimney Type 0 Chimney O Chimney B O Direct Vent • Not Applicable
Heat Loss 0 As Approved • Existing O Not Applicable 1 Value
BTU Rate Q As Per Plan 0 Variable • Other 1 Value 96,000
Use/Nature DUPLEX/REPLACE BOILER **check#23448
of Work
Fees: Valuation $3,600.00 Plan Approval $0.00 Permit Fee Paid $78.00
Issued By: 3 Date 01/17/2013
❑ Permit Voided Parcel Id#0906640000
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 6122 COUNTY ROAD M WINNECONNE WI 54986 -9780 Telephone Number 920-582-4402
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 4&'
P.O.Box 1130 7 g'� 4
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 OJHKOJH
ON 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 greater.
OR
Ifyou are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account El
**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.
/� DATE r' ` / -/L-3
JOB ADDRESS 4//7 (�), (/ 7'n //bit/
•
OWNER /)ea/? &L,hriyol F 1 D
CONTRACTOR `" �' k id �.' o. JAN 1 7 c ol3
mod§ .!Et ritAY ".# iI/'.;
AR i
CHECK HALL APPLICABLE w ifs i f= 1cPJ1 OF
t:OMM .i YDEVELOPMENT
USE CATEGORY 1NISPH:T"ION SERVICES DIVISION
tingle Family ❑Duplex ❑Multi-Family ental ❑Commercial ❑Industrial
FUEL .12Gas DElectric ❑Solid SYSTEM ONew 0Keplace
DOil ❑Solar ❑Other
TYPE d o/lerl
❑Forced Air DRadiant ❑Steam DAJC DVent ❑Electric DHot Water ❑Suppl. DCon. Burner
IS CHIMNEY BEING LINED No DYes -LINER SIZE &MANUFACTURER
Note:All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE OChimney A ❑Chimney B ODirect Vent ❑Other
HEAT LOSS DAs Approved -CI-Existing ❑Not Applicable
BTU RATE DAs Per Plan ❑Variable ❑Other Value
DESCRIPTION/SCOPE OF ALL WORK BEING DONE 742..
a-Aat'L 610/ M- D D D gO I 1 / ' 006 ,87-14
VALUE (Including labor and materials) $ &E,667) '6) U
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
07/07