HomeMy WebLinkAbout0101119- HVAC (a/c)OSHKOSH
ON THE WATER
.lob Address 926 N LARKST
Contractor
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
HOLLAUS HEATING & A/C SERVICE
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner MARLENE M DREW
Category 501 - Residential-Air Conditioning
Electric
Replace
Steam
Suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved ~ Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
101119
04/30/2003
Other J
Vent J
Use/Nature SFR/Install air conditioner.* EIV from Lark Electric attached.
of Work
Fees: Valuation
Issued By:
$1,500.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$27.50
Date 04/30/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1535W BENTAVE OSHKOSH WI 54901 -2730 Telephone Number
(920) 235-7397
OSHKOSH
ON THE WATER
Job Address
Contractor
Fuel
System
926 N LARK ST
HOLLAUS HEATING & NC SERVICE
b~ Gas I
New
Forced Air
Electric
Chimney Type ~ ChimneyA
Heat Loss ~ As Approved
BTU Rate ~ As Per Plan
CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
Owner' MARLENE M DREW
Category 501 - Residential-Air Conditioning
b~ Oil I LJ Electric I
[] Replace I
L~ Radiant I [~ Steam I ~1 A/C
~J Hot Water I ~ Suppl. ~ ~ Con. Burner
Chimney B ~ Direct Vent ~ Not Applicable
~ Existing ~ Not Applicable
~ Variable ~ Other
Value
Value
No 101119
Create Date 04/30/2003
Plan
bd Solid
Other
Vent J
Use/Nature SFR/Install ale conditioner.* ElY from Lark Electdc attached.
of Work
Fees: Valuation
Issued By: ~
$1,500.00 Plan Approval
$0.00 Permit Fee Paid
[] Permit Voided J
$27.50
Date 04~30/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
AgentJOwner
Date
Address 1535W BENTAVE OSHKOSH WI 54901 -2730 Telephone Number
(920) 235-7397
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
O/HKO/H
ON THE: WATER
Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box ! 128,
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 System and have adequate funds, check here
you want this processed through Four account ['
CONTRACTOR
CHECK [] ALL APPLICABLE
DATE
USE CATEGORY
j~Single Family F1Duplex
F1Multi-Famity
F1Rental
F1Commercial
Fllndustrial
FUEL F1Gas nElectric []Solid SYSTEM ~-~'J~,lew-~'
FIOil FISolar []Other
[]Replace
· #t
TYPE
F1Forced Air []Radiant F1Steam F1A/C nVent []Electric []Hot Water F1Suppl.[]Con. Bumer
IS CItlMNEY BEING LINED []No []Yes - LINER SIZE '
Note: All chim_neys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS
BTU RATE
[3Chimney A
I-lAs Approved
[]As Per Plan
[]Chimney B
[]Existing
[]Variable
[]Direct Vent
[]Not Applicable
[]Other Value
•Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials including light fixtures) $/.D/dg~/) ~
ELECTRICAL CONTRACTOR i ,' , .' ':-' ::: ~" ...., DR" . Electric Installation Verification form· attached(If Replacement)
Electrical installation of new~replacement equipment shall be done by licensed contractors.
City of Oshkosh
Division of Insl~ction Services
215 Chttrch Avenue
PO Box 1130
Oshkosh WI 54903=1130
Office 920-236-5050
Fax 920-236-5084
Electric Installation Verification
(We)
(Electrical Contractor Name)
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for/~, .A~Z~//,/~-
' (t~ame o~'party Contracted to)
at the following address:
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe'the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Service
................. Entrance Cables will require a separate permit.
Reconnection or new circuit for the replacement of other permanently wired
appliances / fixtures.
New circuit for the addition of A/C to an individual dwelling unit (house or the
individual systems in a dupleX 0i: condominium), including required service
electrical outlets.
Other
The value of this work is $/.~'"'~. t~ CD
'I hereby verify this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
(Signat~ompanz_O~cer)
(Print Name of Officer)
(Date)
5/02