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Home My WebLink About157050 HVAC (replace furnace) � CITY OF OSHKOSH No 157050 OSHKOSH HVAC PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 1005 HAZEL ST Owner RICHARD/JOANNE T POLLOCK Create Date 08/05/2013 Contractor MODERN SHEET METAL INC Category 500-Residentiai-Heating 8�Ventilating Plan Inspector John Zarate Fuel ✓ Gas Oil _ __ ] Electric Solar _� �li� System � New I ✓ Replace___J Other ___� ✓ Forced Air Radiant _Steam_� A/C �Vent Electric � Hot Water Suppl. Con.Burner Chimney Type Chimney A Q 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 furnace of Work `ck#9900*` Fees: Valuation $2,899.00 Plan Approval $0.00 Permit Fee Paid $62.00 Issued By: � Date 08/05/2013 ❑ Permit Voided Parcel Id#1110230000 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 acti�ity. Signature Date AgenVOwner 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. �;ity of Oshkosh Division of Inspection Services � P.O.Box 1130 � Oshkosh,WI 54903-1130 Phone(920)236-5050 Fax (920)236-5084 ��--� dN THE WATER HVAC PERMIT APPLICATION All information after bold categories must be provided. Incomp(ete 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$100.00 plus the normal permit fee,which ever is greater. OR If vou are a contractor participatinQ in the Permit fee Account Svstem and have adequate funds check here if vou want this processed throu�vour account n **Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Electrical Contractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be snbmitted with the permit application. Applications submitted withont an EIV when snch is reqnired, will not be processed for Permit Issnance and will be retarned for completion. DATE � �� C� JOB ADDRESS D � ��/ �� OWNER �' �1Gii��G�.n �� CONTRACTOR ��'1�3"✓ �y 7�3 � O �r� 11 � E T-1o�—C-- �c/�J�� = • � CHECK 0 ALL APPLICABLE ?�EOAlT}gry'CaR DI: USE CATEGORY Neenah, W154956 �Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial FUEL �as ❑Electric ❑Solid SYSTEM �New �eplace ❑Oil ❑Solar ❑Other ,TYPE �rced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner IS CHIMNEY BEING LINED�No�Yes -LINER SIZ��-?&MANLTFACTURER — "t-�� Note:All chimneys shall be sized per the B'TtJ's being vented. � CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable BTU RATE ❑As Per Plan ❑Variable ❑Other Value DE CRIPTION/SCOP�,OF ALL WORK BEING DONE �� . �i'7�' VALUE (Including labor and materials)$ � �i �� ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) o�/o� � �� a;Y:�.or�s�� xu c�w� AO saec�139 r �w Od�t�od�W[Sd903-1136 II OBre 920-23�5050 � Fa 920-236-SOE4 I _ j �Electric Installatio Veri�catioa , . I (We) �lectrica.l Co tra�ctor Name r Homeowner's Name) � " � � (Address) (City) (State) (Zip Code) accept the cesponsibility to perform the electric work stated below,at the following address: �� /�S� � D . _ (Address where work vyill be performed) � The nature of the work consists of (Check One or D�scribe the Nature of Work) �, Reconnection or new circuit for replacer�ent Heating Plant andfor A/C Condenser. Reconnection or new circuit for replace�ent Electric Water H�eater or power vented water heater. - I Reconnection of the Service Entrance C�ble,Meter Box,alterations to receptacles and tighting fixtures due to siding/s�offrt installation. Note: New Service Entrance Cables will require a separfite permi� Reconnection or new circuit for the repl�cement of other permanently wired appliances/ftxtures. � New circait for the addition of A/C to acji individual dwelling unit, including required service electrical outlets. 71�ote: Homeowners can only do their own electric on a single family owner occ�upied home. Work on a condominium, duplex, rental, or multi-use buildingl,would require a licensed Electrical Coniractor. Other The value of this work is � y� I hereby verify this work will be performed in compliance with the License requirements of Section 11-22 of the Oshkosh Municipal code and further verify the reconnection/installation will be done in compliance with manufacturer and Electric code requirements. �t � �. � �Oj/d�� (Signapue of Company Officer or Homeormer� (Print Name� � � a�ro�