HomeMy WebLinkAbout0154606 - HVAC (furnace) 0 CITY OF OSHKOSH No 154606
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 222 N MEADOW ST Owner ROSINA E KUMBIER Create Date 03104/2013__
Contractor A-1 HEATING&A/C INC Category 500-Residential-Heating&Ventilating Plan _
Inspector Nicole Krahn
Fuel III Gas 1 J Oil 1 PrE-Iiiic 1 [1-Solar J ❑-Solid
System ❑ New I ❑ Replace 1 ❑ Other
yj❑Forced Air 1 j-Radiant J Steam -1 ❑l A/C Vent
L1--Hot W ater 1 Su ppl.
Con. Burner_
Chimney Type Chimney A � Chimney B 0 Direct Vent Ve n t
• Not Applic able
Heat Loss 0 As Approved • Existing O Not Applicable Value
BTU Rate - - -
As Per Plan O Variable • Other 1 Value 54,000
Use/Nature SFR/REPLACE FURANCE,EIV SIGNED BY BELL ELECTRIC "check#11865
of Work
Fees: Valuation $1,500.00 Plan Approval $0.00 Permit Fee Paid $46.00
Issued By: I Date 03/04/2013
❑ Permit Voided I Parcel Id#0609290000
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 W8078 HILLCREST CT HORTONVILLE WI 54944 -9301 Telephone Number 920-779-8838
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
P.O.Box 1130
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084
on 7%* WATFE
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$100.00 plus the
normal permit fee,which ever is greater.
OR
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
• if you want this processed through your account
**Advisory-For applicable projects, an Electrical Installation Verification(EIV)form, signed by the Electrical
/ Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
/ with the permit application. Applications submitted without an EIV when such is required,will not be
processed for Permit Issuance and will be returned for completion.
DATE
JOB ADDRESS ,-'2 N
OWNER / 9 S r n q ti(J OrMotrd 7t
CONTRACTOR A-1 Hearing&AIC
RO. Box 311
CHECK®ALL APPLICABLE Hortonville, WI 54944
USE CATEGORY
Single Family ODuplex ❑Multi-Family [Mental ❑Commercial ❑Industrial
FUEL Gas DElectric 0 Solid SYSTEM ❑New ❑Replace
i1 ❑Solar ❑Other
XPE
orced Air ❑Radiant ❑Steam ❑A/C OVent ❑Electric OHot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINE I/ o❑Yes -LINER SIZE &MANUFACTURER
Note:All chimneys shall be sized per i.e BTU's being vented.
CHIMNEY TYPE ❑Chimney A .❑Chimney B ❑Direct Vent Cl2fOther P✓-.
HEAT LOSS DAs Approved existing ❑Not Applicable
BTU RATE DAs Per Plan OVariable e f Value / 071Z)y.
DESCRIPTION/SCOPE OF ALL WORK BEING DONE F h,.210
VALUE(Including labor and materials)$ /S C)
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) Se!
v07,07
03/01/2013 FRI 10:49 FAX 920 733 2713 Watters Plumbing 0001/001
(*ay cl(C)Alg 001
Dimbollorl hunSealer,
21S.(`hobo Aven.c
PO tae.1 ta0
Tl T Odik11sh Wt 540t;:%,1130 Ti
1 XfJ� UfTka 97P-336•soss
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• Electric Installation Verification
. t(We),. itt L-,...,._.b/._ in e--
(Electrical Contractor Name)
c ._J3 o x 11 g f116n4,sk r I S"Y S 2
(Address) (City) (State) (Zip Code)
have t'eer, contracted to perform electric installation work for ;f fi r,th;i 0 AttC, -.,,
R;n V. er,kta.rt q - 4s"--- Lo-76.,s- (Name of party contracted to)
at the following address: ,2-2-- N • i`'I l)t1L4) S _
(A.ddress where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
_1/Reconnection or new circuit for replacement Electing Plant and/or A/C Condenser.
. Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater. 1.
___. Reconnection of the Service Entrance Cable, Meter Box,alterations is receptaeles
and lighting fixtures due to siding/soffit installation. Note; New Service
Entrance Cables will require a separate permit.
Reconnection or new circuit for the replacement of other permanently wired
appliances/ fixtures. .
New circuit for the addition or A/C to an individual dwelling unit(house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other .
The Voluc of this work is S , _
hereby verify this work will he performed by an employee of this company and further verify
ti c recolmection/ installation will be done in compliance with manufacturefnnd Electric code
&i'
G .��^ ! re-J:6,
(34 h
(tii�;natorc 01 Company Officer) •_ (Print Name of Officer) r (Date)
of
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