HomeMy WebLinkAbout0101498 HOSHKOSH
ON THE WATER
.lob Address 1620 MARICOPA DR
Contractor RASMUSSEN'S HEATING & A/C INC
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner THOMAS F/JOAN HOREJS
Category 501 - Residential-Air Conditioning
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved O Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
101498
05/15/2003
Other
Vent J
3 ton
Use/Nature SFR/Replacement a/c. *EIV form from Slim's Electric.
of Work
Fees: Valuation
Issued By:
$2,500.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$42.50
Date 05/15/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number
920-235-6569
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
Ali information after bold categories must be provided.
Incomplete applications will not be processed.
m/]-KOj'ld
ON THE WATER
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 $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are. a contractor participating in the Permit fee Account System and have adequate funds, check here
if ~.ou want this processed through .your account r'] '
DATE 5-/5-0~:~
JOBAODRrSS /620 t~,,,,~?,~
CONTRACTOR R ~.~ ~.~,.n"~, ~V'At:~ HAY 15200}
CltECK 17I ALL APPLICABLE
USE CATEGORY
12gSingle Family F1Duplex
ElMulti-Family
ORcntal
DEPARTBENT OF
CO~A~I. tNtT¥ DEVELOP~IENT
F1Commercial Fllndustrial
FUEL l~Gas IZEIectric V1Solid SYSTEM EINew 13Replace
EIOil ElSolar VlOther
TYPE
F1Forced Air EIRadiant F1Steam l~adC IDVent nEIectric F1Hot Water rlSuppl. F1Con. Burner
IS C~Y BEING LINED. I~qo VIYes - LINER SIZE
Note: All chinmeys shall be sized Per the BTU's being vented.
& MANUFAC~R
CITIMNEY TYPE
~F. AT LOSS
BTU RATE
ElChimney A EIChimney B ElDirect Vent ElOther
[:lAs Approved J~Exisfing F1Not Applicable
FIAs Per Plan FIVariable ~lOther Value ~ q'o 00
D ¢RUmOS ov ALL WOR .EINO a
%a~I,UE (lndudiog labor and ali mteri~ls including light fixtures)
ELECTRICAL CONTRACTOR ~ { ;~'.~ P5'~_/~.~ ~ ....
~For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
Electric Installation Verification
_ ~(~a8 0,,~,~,~ ar, ,, , O~s~ , , t~i
(.~ular~) ' (cit~) (sta~) (Zip Code)
haw be, eh conlraot~ ~ pert'o~m el~o ~~on work for ..... ~,~?~.~"'~' ~ I-t VA~ ,
(Name of party contracted to)
at the fo]lowing address:
nature o£the work consists oP.. (.Ch~ One or Describ~ the Nature of Work)
....... Rmmncctio~ or n~w cinmit f~ neplaoemeat EleoUio Wate~ Heater or power vented
wal~' heal~.
and lighting fntm'~ dn~ to sidin$ / soffit imtallntiom Noie: N~' Servi~
Namm~ Cabl~ will ~ a separate p~mit
_ R~mm~eofion or new oirouit tilt tim mplaoement of'ol:hor permama~ly wired
The valu~ ofthis work is $. b2~.oo
I hereby verify ~is work will be ~ by an employee of this company and fitrther verify
thc reconnc~on / installation will be done in compliance with manufimumr and Electric code
(i~)