HomeMy WebLinkAbout0157899-HVAC � CITY OF OSHKOSH No 157899
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 803 OTTER AVE Owner THOMAS J/CHERI L HOPPER Create Date 09/24/2013
Contractor CJ MARTIN HEATING&A/C Category 512-Ind.&Comm-Both Plan AA5-3802-0613-
inspector John Zarate
Fuel Gas Oil Electric Solar Solid
System ❑ New J � Replace � Other I
Q Forced Air Radiant Steam A/C Vent �
Electric Hot Water j Suppl. Con. Bu nr er
Chimney Type Chimney A � Chimney B 0 Direct Vent � Not Applicable �I
Heat Loss � As Approved � Existing _ � Not Applicable � Value
BTU Rate As Per Plan 0 Variable � Other Value
Use/Nature OMM/MAKE-UPAIR&EXHAUST HOOD "debit acct
of Work
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Fees: Valuation $10,500.00 Plan Approval $0.00 Permit Fee Paid $184.00
Issued By: � Date 09/24/2013
❑ Permit Voided I Parcel Id#0802170000
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 necessa ap ov b for starting such activity.
�_ /
Signature ���� %� � Date �� ,
AgenUOwner
Address 112 ROSALIA ST OSHKOSH WI 54901 -5455 Telephone Number (920)410-3558
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 Oslikosh
Division of Inspection Services �
P.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050 01HKO.IH
Fax (920)236-5084
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$100.00 plus the
normal permit fee,which ever is greater.
OR
I �ou are a contractor artici atin in the Permit e Account S stem and have ade uate unds check here
i ou want this rocessed throu h ozrr account
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be snbmitted
with the permit application. Applications snbmitted without an EIV when such is reqnired,will not be
processed for Permit Issnance and will be returned for completion.
DATE �°,Z�f' 13
JOB ADDRESS �0/ O�F(�
OWNER �r)�J )DL'JP[� ��5 _ ��aa- o� i3 - N
CONTRACTOR C,/T(/1
CHECK�ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental �ommercial ❑Industrial
FUEL �'Gas ❑Electric ❑Solid SYSTEM ❑New ❑Replace
❑Oil ❑Solar ❑Other
TYPE
❑Forced Air ❑Radiant ❑Steam ❑A/C �ent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED ❑No ❑Yes -LINER SIZE &MANUFACTURER
Note:All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable
BTU RATE ❑As Per Plan ❑Variable ❑Other Value
DESCRIPTION/ COPE OF ALL WORK BEING DONE Mul��-���p� �- �yJ_ �ld�d
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VALUE(Including labor and materials)$ �U,..S(�0
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
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