HomeMy WebLinkAbout0158346-HVAC � CITY OF OSHKOSH No 158346
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1095 N WESTFIELD ST Owner EVERGREEN MANOR INC Create Date 10/16/2013
Contractor HURCKMAN MECHANICAL IND., INC. Category 510-Ind.&Comm-Heating&Ventilating Plan
Inspector Nicole Krahn
Fuel Gas Oil Electric j Solar Solid I
System ❑ New_ _ , �✓ Replace _� Other
Forced Air ' Radiant Steam A/C � Vent_�
Electric �, Hot Water � Suppl. Con. Bum�
Chimney Type �himneyA � Chimney B � Direct Vent � NotApplicable
Heat Loss As Approved � Existing � Not Applicable Value
BTU Rate As Per Plan � Variable � Other Value
Use/Nature iCOMM/EVERGREEN/PHASE III/HVAC to include replacing fans,diffusers and grills, louvers,dampers and piping. *�check#39283
of Work � I
I
I
Fees: Valuation _ $1� Plan Approval $0.00 Permit Fee Paid $1,039.00 - J
Issued dy: Date 10/1 a/2013
❑ Permit Voided � Parcel Id#1608630000
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 Tnspection Services �
P.Q.�ct�113(? �
Oslilcosh,WI 54903-1130
Phone(920)236-5050
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HVAC PERMIT APPLICATION
All information after bold categories must be provided.
i�t2�Atir_caE;nnc witL IIcat be p�x�C+ess�1�
• Application(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services,P4 Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the
aormal gercnit fee,which ever is greater.
OR
If vou are a contraclor partrcipating in the Permit fee Account Svstem and have vdeguate funds check here
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**Advisory-For applicable projects,an Electnical InstaUation Venification(EIV)form,sig�ed by ti�e Elecdrical
Co�tr.actor or Homeowner(for installations allowed to bo peifozmed by the homeowner)nmst be sabmitted
vrith t6e permit application. Applicatians snbmitted withani an EI�wl�en snch is reqnired,�ill�tat be
pmcessed for Permit Issaance and will be retarned For completion.
DATE 1 Q/101 1��
.toB annx�ss Sharehaven 1095 N. Westfield 1ZE�EI�ED
ow�vE�t ��er�reen�.2etirpmPntrnmt„+,�,�t; `
OCT 15 2013
CONTRACTOR Hi�rckman Mer_hani .al Ind �stri _crJnr_
DEPARTAtE�T�F
CHECK�ALL APPLICABLE C0�1VIU�iTY DE�'ELOP�fEyT
INSPECTiOV SER\'ICES Dl�'ISIO:V
USE CATEGORY
aSingLe Family C]Duglex L1Multi-Fami�y ClReut�! �lGomtr�et�isl_ Q.Indu�tri�t
FUEL ❑Gas ❑Electric ❑Solid SYSTEM ONew �Replace
❑Oil �Solar L70ther
TYPE
OForced Air �Raiii:u�t C7St� C1AJC C�Vent OE1�c:tric ❑H�L Wut�r D.SuppL QC�.Surner
1S CHIMNEY BElNG LINED I�No�Yes -L1NER SIZE &MANUFACTURER
Note:A1l ctiimneys shail be sized per the BTU's being ve.nted.
CffiMNEY TYPE ❑Chimney A DChimney B DDirect Vent ClOther
HEAT LOSS I�As Approved �Existing DNot Applicable
HTU RtiTE QAs Per Flan �Variabie O�t�ier ualue
DESCRIPTION/SCOPE OF ALL WORK BEING DONE
HVAG Wixac- Replacing Far}s, Dif�users&GriAes, Lo�vers, Dampers and Piping
VALIJE(Ineluditng lAbor and materials) �� �
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form)
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