HomeMy WebLinkAbout2013-HVAC (furnace) 0 CITY OF OSHKOSH No 155006
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3970 SUMMERVIEW DR Owner DAVID F MAAS Create Date 04/11/2013
Contractor MODERN SHEET METAL INC Category 500-Residential-Heating&Ventilating Plan
Inspector John Zarate
Fuel u Gas [FOIL LI Electric Li Solar {Solid
System ❑ New Replace ❑ Other
[1] Forced Air _J Radiant _1 Steam Li A/C Vent
rj-Eectric Li Hot Water U Suppl. Li Con. Burner
Chimney Type fl Chimney A 0 Chimney B 0 Direct Vent • Not Applicable
Heat Loss 0 As Approved 0 Existing • Not Applicable Value
BTU Rate 0 As Per Plan O Variable • Other Value 60,000
Use/Nature SFR/REPLACE EXISTING FURNACE,WIRING TO BE DONE BY THE HOMEOWNER(David Maas) "check#9594
of Work
Fees: Valuation $2,994.00 Plan Approval $0.00 Permit Fee Paid $62.00
Issued By: bill LA—)
Date 04/11/2013
❑ Permit Voided Parcel Id#1528080000
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 2180 AMERICAN DR NEENAH WI 54956 -1004 Telephone Number (920)733-4713
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.
u//u/
City of Oshkosh
Division of Inspection Services
P.O.Box 1130
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 OfHKOJH
ON THE WATER
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$100.00 plus the
normal permit fee,which ever is greater.
OR
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account f
**Advisory-For applicable projects, an Electrical Installation Verification(EIV)form, signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion. ++��
DATE -/d
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JOB ADDRESS rn��yzeit.cok
OWNER C.1 :12' /7t
CONTRACTOR t//f—/■ V A'�- ��� / / /7
CHECK El ALL APPLICABLE
USE CATEGORY
Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL DElectric ❑Solid SYSTEM ONew Replace
❑Oil ❑Solar ❑Other
T_PE
Forced Air ❑Radiant ❑Steam DA/C ❑Vent DElectric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINEDNo ❑Yes -LINER SIZE &MANUFACTURER
Note:All chimneys shall be sized per t e BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Otl'ier
HEAT LOSS DAs Approved DExisting ❑Not Applicable A
BTU RATE DAs Per Plan ❑Variable ❑Other Value r. v/ . w
DES ' I'TION/SCOPE OF A L WORK I EING DONE %; �� /_. -'<L' I® y'—.—
p4-1.-74/4
VALUE(Including labor and materials)$ 1110r r 95 9L
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
07/07
(Signature of Company Wit=or riomcowncr) krruIa p.w J
0�ro7
cay arashkoeh
Division of Inspection services
215 cum*Avulse
PO Hoes 1130
Oditoth WI 54903-1130
Mee 920.236-3050
a.7wE Fax 920236-5064
,
Electric Installation Verification
I (We) O,,"" BRAS
(Electrical Contractor Name rr Homeowner's Name)
3e776 5ci c-?Jr) Rv,6=,,._) .)�� i OSN/c4'S/-1 4z:- 5(i1ai
(Address) (Ci r) (State) (Zip Code)
accept the responsibil'ty to perform the electric work stated below,at the following address:
3979 - /'.4 5-q% .
(Address where work virf 11 be performed)
1
The nature of the work consists of: (Check One or Describe the Nature of Work)
xReconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance Cble,Meter Box,alterations to receptacles
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 of A/C to an individual dwelling unit, including
required service electrical outlets. Note: Homeowners can only do their own
electric on a single family owner occupied home. Work on a condominium,
duplex, rental, or multi-use building)would require a licensed Electrical
Contractor.
Other
47/ Ae
The value of this work is$ 4 `I�/ ` .
I hereby verify this work will be performed in compliance with the License requirements of
Section 11-22 of the Oshkosh Municipal code and further verify the reconnection/installation
will be done in compliance with manufacturer and Electric code requirements.
' c
(Signature of Company Officer or Homeowner) (Print Name) (Date)
07/07