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� CITY OF OSHKOSH No 155559 `
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OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1313 N MAIN ST Owner GORDON W WISCHOW Create Date 05/10/2013
Contractor MARX MECHANICAL Category 500-Residential-Heating&Ventilating Plan
i
Inspector John Zarate
Fuel ✓ Gas Oil Electric Solar � Solid __ �
S stem New ✓ Re lace �I �
Y ❑ � ❑__ P _ ❑ Other
✓ Forced Air � Radiant � Steam �A/C � Vent
Electric Hot Water � SuppL �Con. Burner�I
�
Chimney Type Chimney A 0 Chimney B � Direct Vent Q Not Applicable �
Heat Loss As Approved � Existing � Not Applicable Value
BTU Rate As Per Plan � Variable � Other Value 90,000
Use/Nature FR/REPLACE EXISTING FURNACE **check#10360
of Work -�i
Fees: Valuation $2,800.00 Plan Approval $0.00 PermitFee Paid $62.00
Issued By: � Date 05/10/2013
❑ Permit Voided � Parcel Id#1501120000
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 4535 STATE ROAD 91 OSHKOSH WI 54904 -6304 Telephone Number 920-235-6510
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.
S
City of Oshkosh
Division of Inspection Services �
P.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050 ����
Fax (920)236-5084
pN TNF WRTER
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$100.00 plus the
normal permit fee,which ever is greater. ,
OR
If vou are a contractor Darticipating in ihe Permit fee Account Svstem and have adeguate /'unds check here
if vou want this processed through vour account n
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Electrical `
Contractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be snbmitted
with the permit application. Applications snbmitted without an EIV when snch is reqnired, will not be
processed for Permit Issaance and will be retarned for completion.
DATE ��1—� ��
JOB ADDRESS I�! � N ���±�N S�� RECEIVED
OWNER �C.��U�a N�. W�SC����
CONTRACTOR �`-�l��� ���k;�r�1 iC� iNC� MAY 0 9 2013
l�EP,IR?':l3E'�T OF
CHECK 0 ALL APPLICABLE C0�1�tU�?''t'isF4'ELOP�fEVT
iNSPECTd�:i�r;:,�;��g Dit'ISIOV
USE CATEGORY
�Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL �Gas ❑Electric ❑Solid SYSTEM ❑New [�Replace ;
❑Oil ❑Solar ❑Other
TYPE
�'Forced Air ORadiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED ❑No L�Yes -LINER SIZE ._�&MANUFACTURER F����
Note:All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B �Direct Vent ❑Other
HEAT LOSS ❑As Approved �JExisting ❑Not Applicable
BTU RATE �As Per Plan ❑Variable OOther Value �0��U 0 �1L1 �NQ��j �
DESCRIPTION/SCOPE OF ALL WORK BEING DONE
d��'�1.�� "IIIc rt.�c�� wl+�t �tfi1N�x f1'lc��L� lla�b u 4� o io
w
VALUE(Including labor and materials)$ ����) �
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Eorm)
o�/o� :