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� CITY OF OSHKOSH No 154739
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3920 EDGEWOOD RD Owner JUDD TARA KING Create Date 12/18/2012
Contractor MCM AIR INC Category 502-Residential-Both Plan
Inspector John Zarate
Fuel ✓ Gas ; Oil Electric Solar j Solid ,
System �✓ New I � Replace j � Other I
✓ Forced Air Radiant Steam � ✓ A/C ✓ Vent
Electric Hot Water Suppl. Con. Burner
Chimney Type ChimneyA 0 Chimney B � Direct Vent � NotApplicable �
Heat Loss As Approved � Existing � Not Applicable Value
BTU Rate As Per Plan 0 Variable � Other ��, Value 80,000
Use/Nature NSFR(LATE PERMIT) /HEATING SYSTEM FOR NEW HOME "check#23529 *(Late fee waived JZ)
of Work
I
I ---�
Fees: Valuation $8,200.00 Plan Approval $0.00 Permit Fee Paid $158.00
Issued By: �1� Date 03/18/2013
❑ Permit Voided I Parcel Id#1280150206
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
AgenUOwner
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 �
P.O. Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 ��K{��N
'�Si THF ti%RT.�F
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 per►nit fee,which ever is greater.
OR
�vou are a contractor parlicipatin� in the Permit fee Account System and have adequate funds, check here
if you want this processed through vour account n
**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 compledon.
DATE 03/14/13
JOB ADDRESS 3920 EDGEWOOD RD.
OWNER JUDD& TARA KING
CONTRACTOR MCM AIR,INC.
CHECK■ALL APPLICABLE
USE CATEGORY
■ Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL ■Gas ❑Electric ❑Solid SYSTEM ■New ❑Replace
❑Oil ❑Solar ❑Other
TYPE
■ Forced Air ❑Radiant ❑Steam ■A/C ■Vent ❑Electric ❑Hot Water ❑Suppl. �Con.Burner
IS CHIMNEY BEING LINED ■No ❑Yes -LINER SIZE &MANUFACTURER
Note:All chimneys shall be sized per the BTU's being ver.ted.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ■ Direct Vent ❑Other
HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable
BTU RATE ❑As Per Plan ❑Variable ❑Other Value 80.000
DESCRIPTION/SCOPE OF ALL WORK BEING DONE
INSTALL NEW CONSTRUCTION-FURNACE—CARRIER 59SC5A
INSTALL A/C—CARRIER COMFORT 13 3 TON
VALUE(Including labor and materials) $ 8200.00
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) SECKAR ELECTR(C
o�/o�