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Home My WebLink About159940-HVAC (furnace) City of Oshkosh Division of Inspection Services P.O.Box 1130 � Oshkosh,WI 54903-1130 � Phone(920)236-5050 Fax (920)236-5084 n,F�,,,�,,,��,�i , g��'��!i . n�v 7.1= ':•i9TFR - HVAC PERMIT APPLICATION All information after bold categories must be provided. MAR 2 8 2014 Incompletc applications will not be processcd. � DEP,�k '1'r��e�J"r' • Application(s)and fee(s)can be brought to City Hall, Room 205 or mailed to Ins ec 1�� `;� �, E Oshkosh WI 54903-1128. Commencing work without permit(s)will result in fees b�ing�bled or$�l��plus the � normal permit fee,which ever is greater. OR If vou are a contractor oarticiDating in the Permit Fee Account Svstem and have adeguate funds check here If vou want this orocessed through vour account n **Advisory-For applicable projects, an Electrical Installation Yerification(EI�form, signed by the Electrical Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted with the permit applicadon. Applications submitted without an EIV when such is required, will not be processed for Permit Issuance and will be retumed for completion. DATE �-��.-/y- JOB ADDRESS ID� E �-G� YI�S`�F' �. OWNER �,,,)L�l✓1 `�I I 5� 1 CONTRACTOR �ICt(��czG�k ti?GC'�'ll?G �C. - CHECK Ef ALL APPLiCABLE US�'CATEGORY l�Single Family �Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial FUEL �Gas ❑Electric ❑Solid SYSTEM ❑New �eplace ❑Oil ❑Solar ❑Other TYPE �orced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric �Hot Water ❑Suppl. ❑Con. Burner IS CffiMNEY BEING LINED �o ❑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 Applicabie BTU RATE ❑As Per Plan ❑Variable ❑Other Value DESCRIPTION/SCOPE OF ALL WORK BEING DONE l�e e 0 t Q 5 IrVI(.�C�, . VALUE (Including tabor and materials)� ��- � . � ELECTRICAL CONTRACTOR (for projects not requiring an EIV Form) �'�(,L�,�,�� ►�u�a � #�(�']fpQo� � v ��'rm;f ��P = ��. `::``' ��,o� City of Oshkosh Division of Inspection Services P.O.Box 1 130 � Oshkosh,WI 54903-1130 � Phone(920)236-5050 Fax (920)236-5084 ��0�� . C�;v T.�p ':�✓ATFR � ELECTRICAL PERMIT APPLICATION A�I information a}�er bold categories must be providcd. lncomplete applications will not be processed. • Application(s)and fee(s)can be brought to City Hall, Room 205 ar mailed to Inspection Services, PO Box 1128, Oshkosh WI 54903-1 128. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the normal permit fee, which ever is greater. OR If vou are a contractor DQYfZC1DClI[Ylp in the Permit Fee Account Svstem and have adeauate funds check here lf vou want thLS Drocessed throuQh vour account ❑ DATE_ -S"v��> - lT JOBADDRESS_ IO�1 r ��Lf'11'1PS�=i' ��j`� OWNER�I'lYl U( �S� CONTRACTOR ��c��-�i<u,I� J�-QGZ.-}'jn � �L�c CHECK �ALL APPLICABLE U� CATEGORY LdSingle Family ❑Duplex ❑Multi-Family ❑Rental ❑Comm ercial ❑Industnal SERVICE �New ❑T mporary TYPE ❑Overhead L'7Not Applicable ❑Change �ot Applicable ❑Underground FILL IN THE APPROPRIATE BLANK WITH THE NUMBER Volts / Receptacles# Circuits# Phase Amps Switches# Fixtures# CHECK 0 ALL APPLICABLE ❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater ❑Fan OR Biower Cl7Furnace ❑A/C ❑Electric Sign ❑Motors ❑Gas Pumps ❑Other DESCRIPTION OF ALL WORK BEING DONE F�lYY1�lC� �'Y pI U(' ►'��' VALUE (Including labor and all materials including light ftatures) MASTER ELECTRICIAN 1,�11 L L�f "Il Y 4 C�P iT �erm�� Pe = �� 3�02