HomeMy WebLinkAbout0156005-HVAC (a/c) �
� CITY OF OSHKOSH No 756005
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1855 S KOELLER ST Owner OSHKOSH LASALLE 93 Create Date O6/03/2013 F
. Contractor CHRISTENSEN HEATING&A/C INC Category 511 -Ind.&Comm-Air Conditioning Plan
Inspector Jon Mueller
Fuel Gas Oil Electric i Solar� Solid �
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System � New � � Replace I �Other _ _
Forced Air Radiant Steam ✓ A/C �] Vent �
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Electric Hot Water Suppl. Con. Burner �
Chimney Type ChimneyA � Chimney B 0 Direct Vent � NotApplicable �I
Heat Loss As Approved 0 Existing � Not Applicable Value
BTU Rate As Per Plan � Variable � Other Value
UselNature OMM(AFFINITY HEALTH)/REPLACE A/C, ELECTRICIAN IS SCHMIDT ELECTRIC "*check#63866,63845 ;
of Work 'i ,
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Fees: Valuation $6,990.00 Plan Approval $0.00 Permit Fee Paid $126.00
Issued By: ��� Date O6/05/2013
❑ Permit Voided I Parcel Id#1307440601
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 1609 W WISCONSIN AVE APPLETON WI 54914 -3274 Telephone Number (920)731-3002
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 �f�K�fl--�
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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$100.00 plus the
normal permit fee,which ever is greater.
OR
If you are a contractor participating in the Permit fee Account Svstem and have adequate funds, check here
if vou want this processed through ,your account n
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be snbmitted
with the permit application. Applications sabmitted withont an EIV when snch is reqnired, will not be
processed for Permit Issnance and will be retarned for completion.
DATE � ��
JOB ADDRESS I�J S� �CY'II C�� ��� ��CEIV :
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OWNER h.11
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CONTRACTOR �-�-J- ��� ,� . � f7� MAY 312013
CHECK fiI ALL APPLICABLE �EPART11E1T OF
C0�1�tU\ITY'DEVELOP�fE.VT
USE CATEGORY INSPECTiO�SER�')CES DI�'ISIOV
❑Single Family ❑Duplex ❑Multi-Family ❑Rental �mmercial ❑Industrial
FUEL ❑Gas ❑Electric ❑Solid SYSTEM ❑New i�KKeplace :
❑Oil ❑Solar ❑Other
TYPE �� �
❑Forced Air ❑Radiant ❑Steam '�'A/C ❑Vent �Electric ❑Hot Water ❑Suppl. �Con. Burner
IS CHIMNEY BEING LINED ❑No ❑Yes -LINER SIZE &MANUFACTURER
Note:All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable
BTU RATE ❑As Per Plan ❑Variable ❑Other Value
DESCRIPTION/SCOPE OF ALL WORK BEING DONE i� 1�Qf�,.,Q,�, ,��,�''(�(�`(���,A (�
VALUE(Including labor and materials)$ `�I T 1� �
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) <_.JL.iI 1���� l��`-��•
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