HomeMy WebLinkAbout0101502-HVACOSHKOSH
ON THE WATER
,Job Address 621 MONROE ST
Contractor
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
GRANT SCHULTZ HEATING & COOLING
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner MICHAEL R/KlM SAWALL
Category 502- Residential-Both
Electric
Replace
Steam
Suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved ~ Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
101502
05/15/2003
Other
Vent J
Use/Nature SFR/Replace furnace and new a/c. *EIV form from Homeowner.
of Work
Fees: Valuation
Issued By:
$3,615.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$60.50
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 1411 S MAIN ST Oshkosh WI 54902 - 0
Telephone Number
(920) 216-1616
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
Q/HKO/H
ON THE t/~Y..~TFR
HVAC PERMIT APPLICATION
All information after hold 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
!f.vou are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account [~
CHECK [] ALL APPLICABLE
USE CATEGORY
[~Singte Family FIDuplex
FIMulti-Farnily FIRental nCommercial Ullndustrial
FIYEL CGas [DElectric F1Solid SYSTEM FINew ~l~eplace
ClOil FISolar 13Other
TYPE
[ForcedAir nRadiant F1Steam t~AJC FIVent nElectric t"lHot Water
UISuppl.
IS CHIMNEY BEING LINED ~hNo nYes - LINER SIZE & MANUFACTURER
Note: All chimneys shall be sized per lhe BTU's being x~ented.
C~Y TYPE UlChimney A [~Chimney B ~tDirect Vent
ItEAT LOSS FIAs Approved ['3Existing FINot Applicable
BTU RATE nas Per Plan nVariable
r-IOther
DESCRIPTION OF ALL WORK BEING DONE
FICon. Burner
ElOther Value
[] For applicable projects, an Electric Installation Verification form, signed by the Eleotrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
I'd GSG~-LC~(O2G) 3/H ~ ~H z3Inqos ~ue~9
eGI :LO CO ~,I Rew
M~ 14 03 O?:lga Grant Schultz Ht~ & R?C (920)237-4959 p.2
City of 0sl~kos~
Division eflnspeetk)n Services
21S C~h A~
~ ~ ~130
~hWI 5~03-1130
0~ ~-~5050
~ax ~2~23~5084
the homeowner(s) of
Electric Installation Verification
(print homeowner(s) name)
(ac[d~r~ ~vhere work is to be peff~ed)
accept the responsibility for performing the electrical work as stated below for the property listed
above.
The nature of the work consists of: (Check one or Describe the Nature of Work)
Recormection or new circuit for replacement Heating Plant and/or A/C Condenser.
Recormection or new circuit for replacement Electric Water Heater or power vented
water heater.
Recormection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reconneetion or new circuit for the replacement of other permanently w/red
appliances / fixtures.
New circuit for the addition of A/C to an individual dwelling unit, including
required service electrical outlets. Note: Homeowners can only do their own
electric on a single family owner occupied home. Y?ork on a condominium,
duplex, rental, or multi-u~e building would require a licensed master
electrician.
Other
The value of this work is $ 3ff~'/"~"-' Od9
I hereby verify this work will be performed by me and further verify tt~e reconnecfion /
installation will be done in compliance with manufacturer and Electric code requirements.
(Date)