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� CITY OF OSHKOSH No �5s1ss
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1015 FREDERICK ST Owner RICHARD UDEBRA J WINKLER Create Date 06/14/2013
Contractor MARX MECHANICAL Category 501 -Residential-Air Conditioning Plan
Inspector John Zarate
Fuel Gas � Oil d Electric—� Solar Q Solid �
System � New � �✓ Replace � Other _�
Forced Air ; Radiant Stea� d A/C Vent
Electric j Hot Water Suppl. Con. Burner
Chimney Type Chimney A � Chimney B � Direct Vent � Not Applicable
Heat Loss As Approved � Existing � Not Applicable Value
BTU Rate As Per Plan � Variable � Other Value
Use/Nature SFR/Replace A/C
of Work
""check#10447'••'
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Fees: Valuation $2,500.00 Pla�Approval $0.00 PermitFee Paid $62.00
Issued By: � Date 06/14/2013
❑ Permit Voided � Parcel Id#1007440000
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.
City of Oslikosh
Division of Inspection Services �
P.O.Box l 130 �
Oshkosh,W] 54903-1130
Phone(920)236-SOSU l
Fax (920)236-5084 �j--��O�H
O:J THF VdATFR
HVAC PERMIT APPLICATION
All infonnation after bold categories must be provided.
lncomplete applicatiot�s will not be processed.
• Applicaiion(s)and fee(s)can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh W1 54903-] 128. Commencing work without permit(s) wiil result in fees being doubled or$100.00 plus the
normal perrr►it fee,which ever is greater.
OR '
ILvou are a contractor�ar>icipatin� in the Permit fee Accounl SVSlena and hal�e adeguate funds, check here
if vou ivant this processed throu�h vour accou�at I—)
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Elecirical
Contractor or Homeowner(for installations�allowed to be performed by the homeowner)must be snbmitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issnance and will be returned for completion.
DAT�-��C�l.�l�
JOB ADDRESS io��� 1 ����-�� ��
OWN�R �lC�l�1�� � Oc'� W�NI�-��'C- JUN 13 2013
CONTRACTOR Narx Nechanical, 3nc
DEPART:�1E\T OF
CO�t�tU\ITY DEVELOPAtE:VT
CHECK 0 ALL APPLICABLE INSPECTiOr SER�'ICES DICISIQV
USE CATEGORY
�Single Family ❑Duplex ❑Multi-Fa�nily ❑Rental ❑Commercial ❑Industrial
FUEL �Gas �Electric ❑Solid SYSTEM ❑New �Replace
❑Oil ❑Solar ❑Other
TYP�
❑Forced Air ❑Radiant ❑Steam (��/C ❑Vent ❑�lectric ❑Hot Watc.r ❑Suppl. ❑Con. Burner
IS CI�IMN�Y B�ING I,IN�D�7'No ❑Yes - L1NER S1Z� &MANUI'AC7UR�R__
Note:Al)chimneys sliall be sized per tl�e BTU's being ventcd.
CI�IMNEY TYP� ❑Chimney A ❑Chimney B ❑Direct Vent �cJOther
HI;AT LOSS ❑As Appmved 17l�xisting �Not A��plicable
I3TU RA7'E ❑As Per Plan ❑Variable OOther Value
llES TION /SCOP� OF ALL WORK BCING DONr
���-PN� P��� v� t TrI ���7v N Q� t'�� l���- 0�� 1�r�
- �,� :
VALUE(Including labo►•and materials)$ ������ '
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
o�/o�