HomeMy WebLinkAbout0101496 HOSHKOSH
ON THE WATER
621 MOUNT VERNON ST
RASMUSSEN'S HEATING & A/C INC
Job Address
Contractor
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 JAMES D/ELAINE KRATZ
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA O 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
101496
05/15/2003
Other
Vent J
60m
Use/Nature SFR/Replacement furnace and a/c. *Homeowner EIV form.
of Work
Fees: Valuation
Issued By:
$4,263.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$69.50
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 lmpection Services
P.O. Box 1130
Oshkosh, WI 54903-I 130
Phone (920) 236-5050
Fax (920) 236-5084
O/HKO_/H
ON THE WATER
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete 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 $100.00 plus the
normal permit fee, which ever is greater.
OR
I_f you are a contractor participating in the Permit fee decount System and have adequate funds, check here
if you want this processed through your account [] - ~
DATE 5"- / ~'-O~
CHECK [] ALL APPLICABLE
USE CATEGORY
I~Single Family FIDuplex
riMulfi-Family
=CEIYED
13Rental nIndustrial
FUEL [~'Gas i-lElectric F'lSolid
I"lOft I-ISolar
SYSTEM I"lNew ~eplace
ElOther
TYPE
I~i~orced Air E3Radiant EISteam El'MC IEIVent ~Electric
IS CglMNE¥ BEING LINED E]No ~/Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE UIChimney A E~Chimney B
WiZ, AT LOSS II,As ~ved
BTU RATE i-lAs Per Plan E]Variable
DESC~ON OF ALL WORK BEING DONE
[3Hot Water E]Suppl. EICon. Burner
&MANUFACTURER
ElDirect Vent ElOther
,l~erApplicable
V ne
VALUE (Including labor and all materials ~elu.~di~g light F~tures. L$ ~ 3. Oa
EI.E~AL CONTRACTOR t'lOmco~o~,er ~: '..~ oeffne.~ ta~ MOm~. *
~For applicable projects, an Electric Installation Verification form, signed by thc Electrical Contractor, must bc
attached. If not attachcd or not applicablc, a separate Elcctrical Permit is required.
(We)
the homeowner(s) of
Electric Installation Verification
(print homeowner(s) name)
(address where work is to be pcr£ormed)
accept the respons/bility for performing the electrical work as siated below for the.property listed
above.
The nature of the work consists
(Che~k One or Describe the Nature of Work)
~n or new ckcuit for rcplacementHeatin__g Plant and/or MC Condenser.
Reconnecfion or n~w circuit for replacement Blectrio Water Heater.
Rcconnecfion ofth~ Sendce Entrance Cable, Motor Box, alterations to receptacles
arid lighting fixtures due to siding / Soffit installaiion. Note: New Service
F, ntnmce Cables will require a separate perngt.
Reoonnection or new oircuit for o~r pemmently w/red appliam~ / fixtures.
Thc value of this work is S.
I hereby verify this work will be performed by mc anti further verify the reconnection I
installation will be done in compliane~ with manufaomrer and Electric code r~luircments.