HomeMy WebLinkAbout0101171-HVAC (a/c)OSHKOSH
ON THE WATER
.lob Address 1216 WHEATFIELD WAY
Contractor MCM AIR INC
Fuel ~J Gas ~
System ~J New
~J Forced Air 1
~J Electric I
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Radiant
Hot Water
Owner ERIC RNVENDY M ELSKAMP
Category 501 - Residential-Air Conditioning
L~ Electric
Replace
L~ Steam
L~ 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
101171
05/01/2003
Other
Vent J
Use/Nature SFR/Install 24m btu A/C. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$2,000.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$35.00
Date 05/01/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 6122 COUNTY ROAD M WINNECONNE WI 54986 -9780 Telephone Number
(920) 582-4402
City of Oahkoah
Diviaion of Impoction Se~rice~
P.O. Box 1130
Oahkoah, WI 54903-1130
?ho~ (920) 2~6-5050
Fax (920) 2~6-5084
· Application(s) and fee(0 can be brought to City Hall, Room 205 or mailed to ~on Setvioe~ PO Box 1128,
Oshkosh W1 54903-1128. Commencing work without permi .t(s) will reault in fee~ being doubled or $100:00 plua the
normal permit fee, which ever is greater.
OR
IF you are a contractor vartlctvattn~ In the')'ermt{ fee .4ccount System and have adequate £unds. Check here
t£ vou want thts_~roces~ed throu~tt your account ["]
6122 COUNTY RD M WINNECONNE, WI 54986
582-4402 FAX 582-0136
CHR~ [i~ AI.I. APPLICABT.R
USE CATEGORY
[~iSinglc Family
ODupl~x
OMulti-Family
r'IRcntal I-ICommcrcial .OIndustrial
FUEL .l~lC,-as OElcctric I-ISolid
OOil OSolar
TYPE
,~Forced Air . ORadiaut C]Steam ~C I 0 V~t
r'lEleotric OHotWater OSuppl. rlCon. Bumer
IS CHIMNEY BEING LINED E]No OYes - LINER S!~
Not~: All chimneys shall b~ sized l~r the BTU's being vented.
& MAN ACl'UR ,
CHIMI~y TYPE
HEAT LOSS
BTU RATE
I'lChil~cy A
OAs Approved
I'lAs Per Plan
OChinmcy B
OExisting
OVariablc
ODirect Vent
r'lNot Applicable
OOther
DESCRH' ON OF? IJ, WORK BEING DONE
VALUE (Including labor and all mat,rlal~ In¢ludlng light fixture}
~LFor applicable projeclz/an Electric Installation Verification form, signed by the ~i l~~, must be
attached. If not attached or not applicable, a separate Electrical Pc, mit is required.
Electric Installation Verification
(Electrical Contractor
have been conlractcd to perform eleotri~ in~tal]atiou work for ~,
The na~e of ~e work co~isl~ off (.Check One or De~n'be the Nature of Work)
Reconnection or new ch~uit for replacement Heagn~ Pl~nt and/or A/C Condenser.
I~.~,o~ection or new circuit for replacement ]~lectric Water Heater or power ve~ted
l~.onncctiol~ of thc Service Bn~rance Cai)lc, Meter Box, ~]tera~ns to reoepta~les
and li~cin$ fixtures due to sidin~ / soffit installagon. Note: New Service
Entrance Cables will require a separa~ permit.
R. eco~eetion or n~,v circuit for Rte replacement of other permaneatly wired
sppliances / fxmres.
N~v ~rouit for the addition of A/c to an ~i~,i~t~! ~weZliag ~ (house or the
individual systems in a duplex or condomim'um), inoludi~.$ reqtired service
eleetri~al otalet~.
The value ofti~s wc~k is $,~.
I hereby verify this work will. be performed byan employee of this company and further verify
the recc~.~octiOn / installation will be done in compliance wt~h manu.~urer and EleCuic code
Oh-int Nan~ of Off/c=) (Dar.=)
/