HomeMy WebLinkAbout092080 - HVAC (furnace) /6"3.''°
Division of Inspection saes
•225 Cluexch Avenue
P.O. Dux 1130
. DI 54903-1130
Fax 1 (920) 236-5004
a,...� Move (920) 236-5048
HVrAC PERMIT APPLICATION
All fields/information after bold categories must be provided.
Incomplete applications will not be processed.
DATE /- 3-o2..
JOB ADDRESS /7/6 ,M 4- V c r" .."\
OWNER E5 yj-cr 7.T.e ries
CONTRACTOR Ro.srh asscir:5 OVA C-
CIRCLLE ALL APPLICABLE
DBE CATEGORY SINGLE F.AMI 1 DUPLEX MULTI-FAMILY COMMERCIAL INDUSTRIAL
FUEL
OIL ELECTRIC SOLAR SOLID
SYSTEM NEW REP_' OTHER
TYPE CFORCSD AIR
RADIANT STEAM A/C VENT
ELECTRIC HOT WATER SUPPL. CON. BURNER
IS CHIMNEY BEING LINED "r5 LINER SIZE 3- MANUFACTURER F1e x r t'ner
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY' TYPE €IMNEY-A ) CHIMNEY B DIRECT VENT OTHER
HEAT LOSS AS APPROVED
.gy — NOT APPLICABLE
BTU RATE
AS PER PLAN VARIABLE OTHER VALUE 'O1OW
NATURE OF WORK:
VALUE (Including labor and 3
d materials) $ ,ac
M •
ELECTRICAL CONTRACTOR o4inG EIreA-Tic.. licensed
Electrical installation of neon/replacement equipment shall be done by
contractors.
Fees
Valuation
$0 to $20.00$1,000.00.
$1,000.01 to $10,000.00 $20.00 for first
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10,000.01 to $25,000.00
$155.00 for first
$10,000.00 plus $1.00 per $100.00 valuation or part thereof
Over $25,000.00 __ _ $305.00 plus $0.50
per $100.00 valuation or part thereof
• Submit payment with application. Failure to pay within 30 days will result in
yon ent � permit fee, which ever is
fees being doubled or $100.00 plus the normal p
ED City ofthltosIt
Dlrmatt d Impolite Sen"°es
215dr&Avulse
pollmt 1130 =
Oshkosh WI 50902400
pl242365060
an tut roan Fax 920436-5W
•
Electric Installation Verification
•
(t)(We) . h EIec*ric
(Electrical Contractor Name)
/{ Sy'6
, of i E• On . r:. (City) (State) (Zip Code)
(Address) .
to perform electric installation work for st. -