HomeMy WebLinkAbout0158341-HVAC i
� CITY OF OSHKOSH No 158341
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Owner EVERGREEN RETIREMENT COMM INC Create Date 10/09/2013
Contractor HURCKMAN MECHANICAL IND., INC. Category 510-Ind.&Comm-Heating&Ventilating Plan BB4-3889-1013H
Inspector Nicole Krahn
Fuel Gas � Oil Electric Solar ; Solid
System New I �✓ Replace � � Other I
Forced Air Radiant � Steam _� A/C Vent 1
_Electric __' Hot Water � �Suppl. � Con. Burner .
--- --- --- --
Chimney Type ChimneyA � Chimney 6 � Direct Vent � NotApplicable
Heat Loss As Approved � Existing � Not Applicable Value
BTU Rate As Per Plan � Variable � Other Value
Use/Nature OMM\PHASE II MANOR VIEW 21 BED CBRF/HVAC in association with the following project: Interior rennovation to enlarge rooms. i
of Work Rennovation will also include updates to the finishes throughout the second floor and the replacement of windows in a portion of the �
building. Work to include replacing fans,fin tube radiation,diffusers and grills, louvers,dampers and piping. **check#39283
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Fees: Valuation $274,500.00 Plan Approval $0.00 Permit Fee Paid $1,574.00
Issued By:�� Date 10/18/2013
� Permit Voided � Parcel Id#1615311000
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.4.Box i t3E? �
Oshkosh,WI 54903-1130
Phone(920)236-5050
�� t9��>2��. 1-� H
ON THF WATFR
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Inccimplete a�plicati�s wFi�-n�be p�c�sse�#.
• Application(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspecrion Services,PO Box 1128,
Oshkosh WI 54903-1 1 28. Commencing work without permit(s)will resuit in fees being doubled or$100.00 plus the
normal pemut fee,�vhich ever is greater.
OR
If vou are a contractor particinatinQ in the Permit fee Accou»t Svstem and have adequate futrds check here
f�kc�u �ccrrt th�s�rocassed tt�r-augk ua�rr �ccuunt �1
**Advisory-For applicable pmjec�ts,an Electnicai Install�tdon Verjfication(EIV)form,signed by the Electrical
Contractor or Homeowner(for installations allowed to be perfoimed by the Lomeowner)mast be snbmitted
�ith tl�e�nmit applicat�on. Applications ssbmii#��it�OSt an EIV whea sac�is req�d,w��eot be
pmcessed for Penmit Issuance and will be ntarned fnr rnmpletlon.
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DATE 10/40/2013
JOB ADDRESS The Manor 1130 N. W _atfiPld Q�
REC�IVEI)
4WNER FvPr�r�n R�?firg�nt-('.n�nm��nEfiT
CONTRACTOR Hurckman MP�hani al Ind ►atriPa,�c 0 C T 15 2013
CHECK Q(ALL APPLICABLE DEPARTI1E\7 OF
C0�1�iU\ITY DEVELOP�fEV7'
USE CATEG�RY INSPECTIOV SER�'ICES DI�'1S10V
❑Single Family ❑Duplex ClMulti-Family ❑Rental �Commercial ❑Tndustrial
FUEL ❑Gas �Electric ❑Solid SYSTEM ONew �IReplace
�Oil OSolar OOther
TYPE
C�Eatced Ai� C1Radiaai E}�team. QA�'C C1V�� �}�ctri� E�Nnt�hlaier C�SuFgL Qec��_B�rne�
IS CffiMNEY BEING LINED�No OYes -LINER SIZE &MANiJFACT'[JRER
Note:All chimneys shall be sized per the BTU's being vented. :
CffiMNEY TYPE ❑Chimney A OChimney B ODirect Vent OOther
HEAT LOSS �As Approved �Existing �Not Applicable
B�'t!RATE. �4s�'er�'ta�e QV�b[� QC�hes�atu�
�/ DESCRIPTION/SCOPE OF ALL WORK BEING DONE
� J�VA(` 1Nnrk- RPnla�in� FansrFin T�►ha Racliatinn��iffi+cprc !� C�rillP�, i roit�arc� tlamnAr�c anrl P� 'n
P+ 9
VALUE(Including labor and materials)$774 5�� � �7 �
.
ELECTRICAL CONTRACTOR(for projects not reqairing an EIV Form)
o�/n�