HomeMy WebLinkAbout157049 � CITY OF OSHKOSH No 157049
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1105 BALDWIN AVE Owner RICHARD POLLOCK Create Date 08/05/2013
Contractor MODERN SHEET METAL INC_ _ Category 500-Residential-Heating 8�Ventilating Plan
Inspector John Zarate
Fuel ✓ Gas �Oil ,� �Electric Solar _� Solid �,
System � New _� �✓ Replace __� [�Other I
✓ Forced Air 1 Radiant Steam A/C � Vent_�
Electric Hot Water �ppl. � 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 fumace -
of Work
*ck#9900"
Fees: Valuation $2,999.00 Plan Approval $0.00 Permit Fee Paid $62.00
Issued By: �_ Date 08/05/2013
❑ Permit Voided � Parcel Id#1110080000
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 2180 AMERICAN DR _NEENAH WI 54956 -1004 Telephone Number (920)733-4713
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.
ELECTRTCAL CONTRACTOR(for projects not requiring an EIV Form)
o�/o�
City of Oshkosh �
Division of Inspection Services
P.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 01HK0�
ON THE WATER
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
�vou are a contractor participatinQ in the Permit 1'ee Account Svstem and have adequate funds, check here
if vou want this processed throu�h vour account (�
**Advisory-For applicable projerts, an Electrical Installation Verification(EI�form, signed by the Electrical
Contractor or Homeowner(for installarions allowed to be performed by the homeowner)mnst be snbmitted
with the permit application. Applications sabmitted without an EIV when snch is reqnired, will not be
processed for Permit Issnance and will be retarned for completion.
DATE ���
JOB ADDRESS !f !/� !il/< � /�(!/�"/� �„✓���/
OWNER �
CONTRACTOR�ZD�733'`7�J� 8 ~ E � 7 M E T A L,
'Tf �lP� ••
CHECK 0 ALL APPLICABLE 2780 American Dr.
Neenah, Wl 54958
USE CATEGORY
�Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL �Gas ❑Electric ❑Solid SYSTEM �New �Zeplace
❑Oil ❑Solar ❑Other
T)lPE
�orced Air �Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED l�Nd' �s -LINER SIZE &MANUFACTURER
Note:All chimneys shall be sized per the BT'b's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS ❑As Approved ❑Existing ONot Applicable
BTU RATE ❑As Per Plan ❑Variable ❑Other Value
DE CRIPTION/SCOPE OF ALL WORK BEING DONE � ' ' s�•r�
.� �. r
� � D� �J
VALUE(Including labor and materials)�) ��� ��
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
o�/o�
o�ro�
i
� �,�� I .
����
� ZuC�Avr� �
PO Bm�1130
� OditoeA WI 54903-!!30 �
O�ee?LO-Y36-SO50
Fmc 9aD-236-SOE4
i
'Eiectric Installatio Verification
� .
I �e) 4 G
(Electrica.l Contractor Name�r Homeowner's Name)
� ^ G� �
� / CJ
(Address) it}�) (Sta.te) (Zip Code)
accept the responsibility to perform the electric work I stated below,at the following address:
l � � � /�� % .�" � . -
/ � �� 0
(Address where work vqill be performed)
�
The nature of the work consists of: (Check One or Describe the Nature of Work)
� Reconnection or new circuit for replacer�ent Heating Plant andlor A/C Condenser.
Reconnectian or new circuit for r�placer�nent Electric Water H�eater or power vented
water heater. - i
Reconnection vf the Service Entrance C� bie,Meter Box,alterations to receptacles
and lighting fixtures due to siding/s�offrt installation. Note: ATew Service
Entrance Cables will require a separ�te permit.
Reconnection or new circuit for the repl�ceme�t of other permanently wired
appliances i fixtures. � �
New circuit for the addition of A/C to acR individual dwelling unit, including
required service electrical outlets. 1V�ote: Homeowners can only do their own
electric vn a single family owner oc�upied home. Work on a condominium,
duplex, nental, or multi-use buildingl would require a licensed Electrical
Coniractor.
Other
The value of this work is � �
I hereby verify this work will be performed in compliance with the License reyuirements of
Section 11-22 of the Oshkosh Municipal code and further verify the reconne�tion/installation
will be done in compliance with manufaciurer and Electric code reqnirements.
, � ,�� C'. �af�a�� �3 4 `�
(Signat�u�e of Company O�cer or Homeowner� (Prini Name� (Dace�
o�ro�