HomeMy WebLinkAbout0154904-HVAC (furnace) � CITY OF OSHKOSH No �54so4
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 350 W 17TH AVE Owner AMIE E GETCHEL Create Date 04/02/2013
Contractor BLACK-HAAK HEATING Category 500-Residential-Heating&Ventilating Plan
Inspector Nicole Krahn
Fuel ✓ Gas Oil Electric � Solar � Solid
System 0 New I � Replace I � Other I
•� Forced Air Radiant Steam A/C Vent
Electric � Hot Water Suppl. Con. Burner �
Chimney Type Q Chimney A � Chimney B � Direct Vent � Not Applicable
Heat Loss � As Approved 0 Existing � Not Applicable Value
BTU Rate As Per Plan � Variable � Other Value
Use/Nature SFR/Installation of a new gas furnace.
of Work
_ �
Fees: Valuation $900.00 Plan Approval $0.00 Permit Fee Paid $30.00
Issued By: �/�� Date 04/02/2013
❑ Permit Voided I Parcel Id#0908540000
In the pertormance 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 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.
������
C'ity of Oshkosh �
Division of]nspection Services APR 012013
P.O. Box 1130 �
Oshkosh, WI 54903-1 l30
Phone(920)236-5050 ��"�'K ����g��
�O,1�TU��Ta � .���P,s��T af HK�1H
Fax (92�)236-5084 INSPEC�'i�1 3�.��s�.ES ndt'ISIOv
_. . 7Hr .;,STFf�
HVAC PERMIT APPLICATION
All inforn�ation after bold categories must be provided.
[ncomplete applications will not be processed.
• A{�plication(s)and fee(s) can be brought to City Hall, Room 20� or mailed to Inspection Services, PO Box 1 128,
Oshkosh WI 54903-1 128. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the
normal permit fee, wilich ever is gceater.
OR
If t oi� U�e a �onh actoi �a�ticipatin� in the Permrt }ee lccozrnt Svstem an�/ hni�e acz'eGitcete fzntc�s chec% {zer�
iF vozr w ant this pi�ocessecl ihrozrgh vozir arcozrnt (�
** Advisory-For applicable projects, an Electrical Installation Verification(EIV)form, signed by the Electric�l :
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 Per,mit Issuance and will be returned for completion.
DATE 3`�i�- 1�j `
JOBADDRESS3�O (� I�I� ��
OWNER �Y�'11� �i IIQ�
CONTRACTOR �JI�' � 0.VL �1 C ' � � �1q3/
CHECK 0 ALL APPLICABLE
USE CATEGORY
Q�Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL (�Gas ❑Electric ❑Solid SYSTEM ❑New C�'f�eplace
❑Oii ❑Solar ❑Other
TYPE
Ck�orced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. OCon. Burner
IS CHIMNEY BEING LINED �No ❑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
aCC! � o� � 5 -FLt Ci
i •`�
VALUE (Incl�ding labor and materials) $ � �C'e ►t��zL����1CXl � �`
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) ��U�v� �IASC�'1 � �tLQYI� ��a,�$�
�-u-K ���in� # � �� "I�
G7!G7
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