HomeMy WebLinkAbout0157612-HVAC � CITY OF OSHKOSH No �s7s�2
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Owner EVERGREEN MANOR INC Create Date O6/19/2013
Contractor HURCKMAN MECHANICAL IND., INC. Category 510-Ind.&Comm-Heating&Ventilating Plan AA5-3813-0713H
Inspector Nicole Krahn :
Fuel Gas � Oil Electric Solar Solid
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System � New � �Replace _ �i [] Other
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Forced Air Radiant � � Steam 'I p A/C � Vent
Electric Hot Water �I Suppl. Con. Burner :
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Chimney Type p ChimneyA � Chimney B � Direct Vent � NotApplicable
Heat Loss i� As Approved � Existing � NotApplicable Value
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BTU Rate p As Per Plan � Variable � Other —�i Value _ _
Use/Nature ,COMM/Evergreen Retirement Community/The addition of two resident rooms and general interior remodeling of Creekview South
of Work lihouseholds 5 and 6. '*check#39211,39206
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Fees: Valuation � Plan Approval $0.00 Permit Fee Paid _ $404.00
Issued By: Date 09/09/2013
❑ Permit Voided I Parcel Id#1608640000
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 P.O. BOX 10977 GREEN BAY WI 54307 -977 Telephone Number 920-499-8771
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 113(? �
Oshkosh,WI 54903-1130
Phone(920}236-5050
Fax (92g)236-5�84 �� H
ON 7HF WATFR .
HVAC PERMIT APPLICATION
Al1 information a.fter bold categories must be provided. '
Incompiete appticatians wiii not be processed.
• Application(s)and fee(s)oan 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 narticipating in the Permit fee Account Svstem and have adeauate funds. check here
if vou K�a�rf tfris pracess�d through vour aceauet ❑
**Advisory-For applicable projects,an Etectrical Installation VeriScation(EI�form,signed by the Elec�ical
Contiactor or Homeowner(for installations allowed M be performed by the homeownrr)mnst be snbmitted
with the ptrmit application. Applicarions submitted withont an EIV when such is reqofred,will�ot be
prucessed for Peimit Issaance and will be ret�nrned for compleNon. .
D�TE 8l27/13
JOB ADDRESS 1130 N.Westfieid Street Oshkosh,WI 54902
I�IVEL�
OWNER___E_vergreen '1130 N.Westfieid Strest Oshkosh.Wi 54902 ';!
SEP 0 3 2013
CONTRACTOR Hurckman Mechanical industries, tnc. 1450 Velp Avenue Green Bay,WI 54303
DEPARTIIE\T OF
COJI�fU\ITY DE�'ELOP�IEVT
CHECK BI ALL APPLICABLE 1NSPECTIpY SER\�1ces�n��s��v
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental �Commercial ❑Industrial
F[JEL ❑Gas OElectric OSolid SYSTEM �New ❑Replace
C�OiI ClSolar �4ther
TYPE
C1Forced Air aRadia�t ❑Stea� ❑A/C ❑Vent QElectric OHot Water ❑Suppl. C]Con.Burner
IS CHiMNEY BEING LiNED�No�Yes -LINER S1ZE &MANiJFACTURER
Note:Ail chimneys shall be sized per the BTU's being vented.
CffiMNEY TYPE ❑Chimney A �Chimney B ODirect Vent �Other
HEAT LOSS DAs Approved �Existing �Not Applicable
BTU RATE �As Per Plan �Variable �Othe Va1ue
DESCRIPTION/SCOPE OF ALL WORK BEING DONE UTl L, ! ��J r
YALUE(Ieeladiag mbur a�d materisls)
ELECTRICAL CONTRACTOR(for projects not requirieg an EIV Form)
0�/07