HomeMy WebLinkAbout0156364-HVAC n CITY OF OSHKOSH No 156364
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1125 N WESTFIELD ST Owner EVERGREEN MANOR INC Create Date 05/09/2013
Contractor MCM AIR INC Category 512-Ind.8�Comm-Both Plan Z5-3739-0413-H
Inspector Nicole Krahn
Fuel Gas Oil ✓ Electric Solar Solid __�,
System � New � �✓ Replace _� � Other
Forced Air i Radiant Steam A/C �Vent
✓ Electric Hot Water Suppl. Con. Bumer i
Chimney Type ChimneyA � Chimney B � Direct Vent � NotApplicable
Heat Loss AsApproved � Existing � NotApplicable Value __
BTU Rate As Per Plan � Variable � Other Value
Use/Nature OMM/INSTALL PTAC UNITAND CHIMNEY LINER '*check#23625,23666
of Work ,
I
� �I
!I
I �I
Fees: Valuation $3,000.00 Plan Approval $0.00 Permit Fee Paid $62.00 �
Issued By: ���� Date 06/24/2013
�
❑ Permit Voided � Parcel Id#1608630100
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 6122 COUNTY ROAD M WINNECONNE WI 54986 -9780 Telephone Number 920-582-4402
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 ]130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 �����
QN THF V,�AT;'R
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 contructur pariicipating in tne Permii ;ee��c�u•zt Svs'em and hati» adagu�i� funds check here
if you want this processed throuQh your account n
**Advisory-For applicable projects, an Electrical Instailation Verification(EIV)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 completion.
DATE OS/09/13 :
JOB ADDRESS 1125 N. WESTFIELD ST. ���,�g�.E�
OWNER EVERGREEN RETIREMENT .
CONTRACTOR MCM AIR,INC. MAY 10 2013
DEPAR'IAE°`--;�p
CHECK�ALL APPLICABLE C0�11fUNITY D�' _.pp,ygyT
INSPECTif3N SER?'lCES�(�'1S10!V
USE CATEGORY
Single Family ❑Duplex ❑Multi-Family ❑Rental ■Commercial ❑Industrial
FIJEL ■Electric ❑Solid SYSTEM �New ■Replace
❑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 3" &MANUFACTURER
Note:All chimneys shall be sized per the BTU's being vented.
CffiMNEY 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
INSTALL PTAC UNIT AND CHIMNEY LINER
VALUE(Including labor and materials) $ 1300.00 �.pOV. U J
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) SECKAR
o�/o�