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Home My WebLink About2013-HVAC (furnace) � CITY OF OSHKOSH No 156222 OSHKOSH HVAC PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 1312 RUSH AVE Owner TERRIELYNN A ARNOLD Create Date 06/17/2013 Contractor BLACK-HAAK HEATING _ Category 500-Residential-Heating&Ventilating Plan Inspector John Zarate Fuel ✓ Gas Oil Electric � Solar Solid � System � New I �✓ Replace ! � Other �i ✓ Forced Air Radiant � Steam A/C ' Vent I Electric Hot Water Suppl. Con. Bumer 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/gas firnace replacement I of Work "*"check#4930***' I � , _ I Fees: Valuation $2,300.00 Plan Approval $0.00 Permit Fee Paid $62.00 Issued By: ''�.y� Date O6/17/2013 ❑ Permit Voided j Parcel Id#1610370000 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 7075 APPLETON WI 54912 -7075 Telephone Number 920-757-9990 To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Pertnit 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 specifed 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 O �KO u i i ON THF WATFR � 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$100.00 plus the normal permit fee,which ever is greater. OR If vou are a contractor participating in the Permit fee Account System and have adeguate funds check here if vou want this processed through your account n **Advisory-For applicable projects, an Electrical Installadon Verification(EI�form, signed by the Electrical Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted with the permit application. Applications submitted without an EIV when such is required, will not be processed for Permit Issuance and will be returned for compledon. DATE �- ��-I�J JOB ADDRESS I��ia (�u.5h �v-e� REC�IVED ow1vER Terr�i� �r�tplc� JUN 17 2013 CONTRACTOR gla.�fc- f�aQk I-IQCrF-i`nu . T c - � � DEP.:RTAIE�'f OF. CO�1�tU1iTY DEVELOP�tEVT CHECK�ALL APPLICABLE INSPECTIO�SERVIC£S DI\"iS10V U�CATEGORY Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial FUEL UdGas ❑Electric ❑Solid SYSTEM ❑New C3Replace ❑Oil ❑Solar ❑Other TY�E C�orced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner IS CHIMNEY BEING LINED ❑No Ga'i'es -LINER SIZE 1_ ��&MANUFACTURER QX - �-1 Note:All chimneys shall be sized per the BTU's being vented. CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable BTU RATE ❑As Per Plan ❑Variable ❑Other Value DESCRIPTION/SCOPE OF ALL WORK BEING DONE�aS -�,C,ir�LQ�e.. V'Q.r7I tL�P�� 00 : VALUE(Including labor and materials)$�;�D • ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) �(/Jh ,�,4�°`%/ � �p�!�O �P o�/o� 1��Y rn',-� �-�� = °�b� �° City of Oshkosh Division of Inspection Services � P.O.Box 1130 � Oshkosh,WI 54903-1130 Phone(920)236-5050 Fax (920)236-5084 fHKO� ON iHE WATFR � ELECTRICAL 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$100.00 plus the normal permit fee,which ever is greater. OR If vou are a contractor participating in the Permit Fee Account Svstem and have adeauate funds check here if vou want this nrocessed through vour account ❑ DATE b- l a-� 3 JOB ADDRESS 13�a f��, 1� OWNER �ef(V 1-C' }�f"{'►'!0��1 CONTRACTOR ��GIC�L- ��CCCt.a �Q(,qr1�q, ,L�lC � CHECK�ALL APPLICABLE . US�',.CATEGORY �� Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial, SERVICE ONew ❑Te orary TYPE ❑Overhead �Applicable ❑Change ot Applicable ❑Underground FILL IN THE APPROPRIATE BLANK WITH THE NUMBER Volts / Receptacles# Circuits# Phase Amps Switches# Fiztures# CHECK 0 ALL APPLICABLE ❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater ❑Fan OR Blower �ace ❑A/C ❑Electric Sign ❑Motors ❑Gas Pumps ❑Other DESCRIPTION OF ALL WORK B�ING DONE -�ZC✓'t�U.l�:� �,�lQC' ,P'}'lQ,h� � � VALUE (Including labor and all materials including light fiztures)$ 10 D . � MASTER ELECTRICIAN �I�/1� /),G<<SG� � /�"l D8� 3/02 �Vh'1�� 2 � � r � �