HomeMy WebLinkAbout0154821-HVAC (furnace) /�'� CITY OF OSHKOSH No 154821
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 2228 OREGON ST Owner JENNIFER J FLEISCHMAN Create Date 03/22/2013
Contractor BLACK-HAAK HEATING Category 500-Residential-Heating&Ventilating Plan
Inspector Nicole Krahn
Fuel ✓ Gas Oil Electric Solar 1 Q Solid J
System � New I []✓ Replace ' Other �
✓ Forced Air Radiant Steam__� A/C�� Vent '�
Electric Hot Water Suppl. Con. Bume�
Chimney Type ChimneyA 0 Chimney B � Direct Vent � NotApplicable-�I
Heat Loss As Approved � Existing � Not Applicable Value
BTU Rate As Per Plan � Variable � Other Value
Use/Nature FR/REPLACE FURNACE, ELECTRICIAN IS ALVIN RUSCH "check#3555 (
of Work !
i
',
i
i
Fees: Valuation $3,000.00 Plan Approval $0.00 Permit Fee Paid $62.00
Issued By: �'�(/�J Date 03/22/2013
❑ Permit Voided � Parcel Id#1402680000
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 of Oshkosh
Division of Inspection Services �
P.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 n J'(_..�K .I H
�JJ I 1
ON 1NF WATFR
(� HVAC PERMIT APPLICATION
��(� Yt,'�i � �;,� Ql� All information after bold categories must be provided.
f S 1,� �O ��t IG�fS� Incomplete applications will not be processed.
l
• App ication(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$100.00 plus the
normal permit fee, which ever is greater.
OR
If vou are a contractor narticipating in the Permit fee Account Svstem and have adeauate funds check here �
if vou want this processed throu�vour account n
**Advisory-For applicable projects, an Electrical Installation Verification(EIV)form, signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
DATE �1�1C I I3
JOB ADDRESS � � � �' �r'
OWNER 01,I')(01 " �1 1,�t'
CONTRACTOR {�' " � � � - � I I I nI�
CHECK�ALL APPLICABLE
USE CATEGORY
�(Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL �Gas ❑Electric ❑Solid SYSTEM ❑New �Replace
❑Oil ❑Solar ❑Other
TYPE
�I�Forced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED �1No ❑Yes - LINER SIZE & MANUFACTURER :
Note:All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS ❑As Approved �Existing ❑Not Applicable
BTU RATE ❑As Per Plan ❑Variable �Other Value
DESCRIPTION/SCOPE OF ALL WORK BEING DONE �P,�il(ACT P, Fid.r'V'�.AC�
VALUE(Including labor and materials)$ �����.�� �
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) g�G{G��(�{��,�����^� �I�'L� ,
o�/o�