HomeMy WebLinkAbout0158908-HVAC (boiler) i
� CITY OF OSHKOSH No 158908
OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 918 HURON AVE Owner DAVID/KATHLEEN SCHLICHTING Create Date 11/26/2013
Contractor BLACK-HAAK HEATING ___ Category 500-Residential-Heating&Ventilating Plan
Inspector John Zarate
Fuel ✓ Gas Oil 1 Electric Solar � Solid
System ❑ New � �✓ Replace I � Other �
Forced Air Radiant � Steam � A/C , Vent
Electric i ✓ Hot Water Suppl. Con. Burner
Chimney Type ChimneyA 0 Chimney B _ � Direct Vent _ _� NotApplicable�,
---- ---- —
HeatLoss AsApproved � Existing � NotApplicable I Value
___.___— ------ ;
BTU Rate As Per Plan � Variable � Other 1 Value
Use/Nature FR/REPLACE BOILER, ELECTRICIAN IS ALVIN RUSCH *'check#5950
of Work
—----- --- �
Fees: Valuation $4,900.00 Plan Approval $0.00 Permit Fee Paid $94.00
Issued By: � Date 11/26/2013
❑ Permit Voided I Parcel Id#1510720000 '
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 PO BOX 7075 APPLETON WI 54912 -7075 Telephone Number 920-757-9990
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.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050
Fax (920)236-5084 Q�HK_ o1H
. (�N THC ���✓.qTFR
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Tncomplete 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
�vou are a contractor participating in the Permit fee Account System and have adeguate funds check here
if vou want this Drocessed through your account n
**Advisory-For applicable projects, an Electricai Installation Verification(EI�form, signed by the Electricai
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion. .
DATE �!-a'�5 - /3
JOB ADDRESS_ �� � 17/•c{�D h !7U-�
OWNER I� f Q��� ' CiC /I �EC.EIVE�
CONTRACTOR G[C ' - ��«� �� � � � NOV 2 6 2013
CHECK�ALL APPL�CABLE
[3EP��12Ti��:>?OF
U�E'CATEGORY CO�1�iL'1iTk'?�El�Ed.C)p'�1EVT
1VSPECTl�I': *�?.s�:4'i<'E�r�i�'ISIOV
�Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
FUEL f9�as ❑Elech-ic ❑Solid SYSTEM ONew C�e lace
❑Oil ❑Solar ❑Other
TYPE �
❑Forced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric L✓JHot Water ❑Suppl. ❑Con. Burner
IS CHIMNEY BEING LINED �o ❑Yes -LINER SIZE &MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CffiMNEY TYPE ❑Chimney A ❑Chimney B ❑Direct Vent ❑Other
HEAT LOSS ❑As Approved ❑Existing ❑Not Applicable
BTU RATE ❑As Per Plan ❑Variable ❑Other Value
DESCRIPTION/SCOPE OF ALL WORK BEING DONE_ bD t�i� YQ�1 u�e✓j-ce��f
VALUE(Including labor and materials) $ �};�!�%D•1�
ELECTRICAL CONTRACTOR(for projects not requiring an EIV Form) �j�//✓� �((,5(;'�j � ���Q�[��
J �
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