HomeMy WebLinkAbout0154894-HVAC �
� CITY OF OSHKOSH No 154894
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 2017 JACKSON ST Owner FAMILY DOLLAR STORES OF WISCONSI� Create Date 03/22/2013
Contractor VALENTINE HEATING&COOLING Category 512-Ind.&Comm-Both Plan z2-3714-0313
Inspector John Zarate
Fuel ✓ Gas Oil Electric Solar I Solid i
System ❑✓ New I � Replace � Other '
✓ Forced Air i Radiant Steam _� A/C Vent
Electric Hot Water � Suppl.� Con. Burner ,
Chimney Type ChimneyA 0 Chimney B � Direct Vent � NotApplicable
Heat Loss I� As Approved � Existing � Not Applicable Value _ _
---- --- — --- -- --- :
BTU Rate As Per Plan � Variable � Other �I Value ;
; -- - -- __ — ------ _
Use/Nature omm/New Store*Family Dollar. Per State approved plans trans ID.2202503 "*check#1077
of Work
i
�
I
i I
Fees: Valuation $37,762.00 Plan Approval $0.00 Permit Fee Paid $394.00
Issued By: � Date 04/01/2013
❑ Permit VoidedJ Parcel Id#1219090100
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the easement
holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
AgenUOwner
Address W2027 INDUSTRIAL DR KAUKAUNA WI 54130 -7517 Telephone Number (920)788-5369
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Pho�e
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
;`
� �-;f ;�
, � : `� ��-.
City of Oshkosh
Division of lnspection Services �
P.O.Box 1130 �
Oshkosh, WI 54903-1130
�� Phone(920)236-5050
� Fax (920)236-5084 ���--�K�
� ON THF WATFR
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
• Application(s)and fee(s)can be brought to City Hall,Room 205 ar mailed to inspection Services, PO Box l 128,
Oshkosh WI 54903-1128. Commencing work without permit(s)will result in fees being doubled or$]00.00 plus the
normal permit fee,which ever is greater.
OR
If vou are a contractor participatin� in the Permit fee Account Svstem and hai�e adeguate funds, check here
if vou want this processed through your account n
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form,signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be sabmitted
with the permit application,�Applications snbmitted withont an EIV when snch is reqnired, will not be
processed for Permit Issnance and will be retarned for completion.
DATE 1��bn-h �I,�o�3
JoB Ann�ss o�C�I � �Q-C�S on �
.
���EIVEfl�
OWNER�cem�e,�- C�n�-�-�.t-� 6 .
cortTRacTOR U.�e��i n� , �r�� APR 012013
CHECK�ALL APPLICABLE �Ep����'=�1E�T OF
COII�fU�i'PY DEVELOPI1EVT
iNSPECT)n�v�F��y�CES Di�'iSIOV
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental °�Commercial ❑Industrial
FUEL �Cias ❑Electric ❑Solid SYSTEM �New ❑Replace
❑Oil ❑Solar ❑Other
TYPE
�Forced Air ❑Radiant ❑Steam �1/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con.Burner
IS CAIMNEY BEING LINED �INo ❑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 �. a -3�►y -b 3 �3
HEAT LOSS �'As Approved ❑Existing ❑Not Applicable
BTU RATE ,�As Per Plan ❑Variable ❑Other Value
DESCRIPTION/SCOPE OF ALL WORK BEING DONE /���I C S� 2 7vV
jt/-1 w CJv�J/it'Lll/L i�O �/����� � / / - �� ,���
K�Ha� s �J w�u ,��;�, ,� �� w� d cc�� � rr�i s l�s' ,
VALUE(Including labor and materials)$
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
Zf0..���.,� �N` _ �,Z�s�,�.��b.�-,��� �u� e �`CIA�v� o�,o,
�