HomeMy WebLinkAbout0158340-HVAC � CITY OF OSHKOSH No 158340
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Owner EVERGREEN RETIREMENT COMM 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 ! Solar Solid
System ❑ New I �✓ Replace I � Other _�
Forced Air Radiant Steam -� A/C Vent
Electric Hot Water Suppl. Con. Burner
Chimney Type Chimney A � Chimney B � Direct Vent � Not Applicable �
Heat Loss �As Approved � Existing_ � Not Applicable Value
BTU Rate As Per Plan � Variable � Other 1 Value
Use/Nature OMM/EVERGREEN(THE GARDENS)/Hvac work to include replacing fans,fin tube radiation,diffusers and grilles,louvers,dampers
of Work nd piping. '*check#39283
i I
I
Fees: Valuation $157,500.00 Plan Approval $0.00 Permit Fee Paid $984.00
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 ofInspection Services �
P.O.Bc�x I�3Q �
Oshkosh,WI 54903-1130
Phone(920)236-5050
�� t�,�-�� �C H
ON THF WATFR
HVAC PERMIT APPLiCATION
All information after bold categories must be provided.
Incvmplete a�ic�ions wil�-nc�t be p�ro�d.
• Application(s)and fee(s)can be brought to City Hall,Room 20S or mailed to Inspection Services,PO Box 1128,
Oshkosh Wl 54903-1128. Commencing work without permit(s}will result in fees being doubled or$100.00 plus the
�ar�al perc�it fe�,which ever is greater.
OR
I f you are a contractor g„articipati»g in the Permit fee Account Svstem and have adequate funds. check here
if you want thi�roce.rsed tirrorrQh vnur account n
**Advisory-For applieable pmjects,an Electrlcal Installadon Verifieation(EI�form,sigaed by the Electrical
Co�tcactor or Homeowner{for installations allowed tn be peiformed by the homeowner)amst be sab�tntted
�ritfi the ptrmit appiicatian. App�atian�submiHtd witfie�at aa Eiy�v�utn s�h is nqnired,v�il1 not be
pmcessed for Penndt Lssaance and witl be retonned f�or rnmpletton.
�,� �,.�.��� QATE ��„Q�Q�3
aoB nnn�ss The Gardens 'i�f5 _ RECEIVED
ovvx��r��Qt�r�t,t.t;nmmunii�.
CONTRACTOR Hurr.kman Mechanical Ind�ctri�, 1�_ 0 C T 15 2013
DEPART�IEIT OF
CHECK 0 ALL APPLICABLE C0�1�1U\iTY DEVELOP�fEVT
iNSPEC'fiOV SERVICES DI�'IS10V
USE CA7'�GORY
❑Single Family ❑Duplex ❑Multi-Family �Rental ISJCommercial ❑Industrial
FtJEL ❑Gas �Electric ❑Solid SYSTEM �New {�Replace
ClOil ❑Solaz OOther
TYPE
OForced Air �Radiant ❑Stea}n DA/C OVent �Electric �Hot V�ater ❑Suppl. DCOri.Bll1'�IEF
IS CHIMNEY BEING LINED�No�Yes -L1NER SIZE &MANUFACTURER
Note:All chimneys shall be sized per die BTU's being veirted.
CHIMNEY TYPE ❑Chimney A �Chimney B �Direct Vent ❑Other
HEAT LOSS �As Approved DExisting ONot Applicable
BTt�B�.LTE. C1As Per�lan_ d_Vaziabls Clt?ther Va1ue
DESCRIPTION/SCOPE OF ALL WORK BEING DONE
HVAf.iflfi�rk-f�p�farar a �an5,, fin Tiit�Radiatinti, f]iffi�cp.r�R [;riilnc� !raivprc namnarc anri PiP�MJ
VAI.UE(lnciuding labor and materials) .vv
ELECTRICAL CONTRACTOR(for projects not requiriag an EIV Form)
os/o�