HomeMy WebLinkAbout0155338-HVAC � CITY OF OSHKOSH No 155338
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Owner MERCY MEDICAL CENTER OSH INC _ Create Date 04/23/2013
Contractor AUGUST WINTER 8�SONS INC Category 511 -Ind.&Comm-Air Conditioning Plan
Inspector Nicole Krahn
Fuel Gas i Oil Electric Solar Solid
System � New � �✓ Replace j � Other I
Forced Air Radiant Steam A/C Vent
Electric Hot Water Suppl. Con. Burner
Chimney Type ChimneyA � Chimney B 0 Direct Vent � NotApplicable
Heat Loss As Approved � Existing � Not Applicable Value
____ _
BTU Rate As Per Plan � Variable � Other � Value _ _
Use/Nature OMM/REPLACE DEDICATED CHILLER FOR LINEAR ACCELERATOR EQUIPMENT,VERIFY(CFM)AIR QUANTITIES FOR THE
of Work PROCEDURE ROOM "check#562422
i
Fees: Valuation $30,250.00 Plan Approval $0.00 Permit Fee Paid $354.00
Issued By: �(�,) Date 04/30/2013
❑ Permit Voided � Parcel Id#0613660000
In the performance of this work, I agree to perForm all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the easement
holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
AgenUOwner
Address PO BOX 1896 APPLETON WI 54912 -1896 Tele hone Number
P (920)739-8881
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Division of Inspection Services �
P.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 ��_��
t�`�t TNE��l+/P,TER
HVAC PERMIT APPLICATION �
All information after bold categories must be provided.
Incomplete applications will not be processed.
• Application(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services,PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s)will result in fees being doubled or$]00.00 plus the
normal permit fee,which ever is greater.
OR
�f,,.,u are a contractor participatinQ in the Permit fee Account Svstem and have adequate funds, check here
if vou want this processed throuQh vour account n
**Advisory-For applicable projects, an Electrical Installation Verificadon(EIV)form, signed by the Electrical F
Contractor or Homeowner(for installadons allowed to be performed by the homeowner)must be submitted �
�
with the permit application. Applications submitted without an EIV when snch is required, will not be
processed for Permit Issuance and will be returned for completion.
DATE �-23�l3
JOB ADDRESS SDO 5• Da�woccQ Qd. � DS�Iti.� W I 9�1�-'19�'�r
OWNER /✓IGrcv�•� C�e��(-
CONTRACTOR �w�!- Inl uv�tr � �ar�9i
CHECK 0 ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental (�Commercial ❑Industrial
FUEL ❑Gas ❑Electric ❑Solid SYSTEM ❑New �Replace
❑Oil ❑Solar N� ❑Other
TYPE r1Fk
❑Forced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED ❑No ❑Yes - L1NER SIZE &MANUFACTURER
Note:All chimneys shall be sized per the BTU's being vented. rJ h
�
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other #
N� HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable
BTU RATE ❑As Per Plan ❑Variable ❑Other Value
DESCRIPTION/SCOPE OF ALL WORK BEING DONE
— �lac� �c�.�td �.:Gtu �r- �+.+.Qar- AutFi�a�o�- ��►��o,r�o-n.�P'.
v.a, r��.� �- ��� -�- � P�.� �,�
VALUE(Including labor and materials) $ � ZS"D
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) J p,,,^�r-+�- �p��-�L
o�/o� �