HomeMy WebLinkAbout0081813-HVAC (a/c) � �
� CITY OF OSHKOSH No 0081813
OSHKOSH HVAC PERMIT -APPUCATION AND RECORD
ON THE WATER
Job Address 2461 SECURITY DR Owner SECURITY HOMES Create Date 10/04/2000
Contractor MARX HEATING Category 501 -Residential-Air Conditioning Plan
Fuel Gas Oil ✓ Electric Solar Solid
System �✓ New � �Replace � � Other j
Forced Air Radiant Steam ✓ A/C Vent
Electric Hot Water Suppl.� Con.Bumer
Chimney Type Chimney A Chimney B Direct Vent Not Applicable
Heat Loss As Approved Existing Not Applicable Value
BTU Rate As Per Plan Variable Other Value
Use/Nature FR/INSTALL NEW 2-1/2 TON A/C UNIT AND AIR CLEANER
of Work No electric permit required-received installation verification signed by Van Ert Electric)
Fees: Valuation $1,640.00 Plan Approval $0.00 Permit Fee Paid $30.50
Issued By: c��� S Date 10/04/2000
❑ Permit Voided ,
In the performance of this work,I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 4535 STATE ROAD 91 OSHKOSH W I 54904 -9244 Telephone Number 235-6510
. + `� ,;��,
� Division of Inspection Services
� 215 Church Avenue
P.O. Box 1130
'�.1L�! Oshkosil, WI 54903-1130
Fax # (920) 236-5084
UN fHE wnlER '
Phone (920) 236-SC48
HVAC PERMIT APPLICATION
All fields/informar_ion after bold categories must be provided.
Incomplete applications will not be processed.
DATE I Q —a�.�Q
JOB ADDRE S S �j�t0 I c����t T�-1 ��
o�R MZ�1�1 A��-t�
CONTR.ACTOR_�� �4�TI�U t � IC I I�L�
CIRCLE ALL APPLICABLE
IISFs CATEGORY SINGLE FAT�IILY' DUPLEX ML'LTI-FAMILY COMAIERCIAL, INDUSTRIAL
FIIEL GAS OIL ELECTRIC �. SOLAR SOLID
SYSTEM N_ E�� REPLACE OTHER :
TYP$ FORCED AIR RADIANT STEAM A/C� VENT
ELECTRIC HOT WATER SUPPL. CON. BURNER
IS CFiIMNEY BEING LINED 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 APPLICABLE
BTII RATE AS PER PLAN VARIABLE OTHER VALUE
NATIIR$ OF WORR: r n� J 1 t-�L�- � �I� � TT �C_ �� l� � fl"I� C L����
f�l
VALIIE (Including labor and materials) $ 'tQ�(Q • ��
SLBCTRICAL CONTRACTOR � � �,�T-
Electrical installation of new/replacement equipment shall be done by licensed
contractors.
Valuation Fees
$0 t o $1,0 0 0.0 0........_._...._._._._...._._....M_._._._.___._.__._.__._._.__._._._._._..._....�...._._._..$2 0 .0 0
$1,0 0 0 .O 1 t o $10, 0 0 0 .0 0.._._._._._._.........._......._.......__................_......._._._...._.........._._._..$2 0 . 0 0 f or f i r s t
$1, 000 .00 plus $1.50 per $100 .00 valuation or part thereof
$10, 0 0 0 .O 1 t o $2 5, 0 0 0 .0 0........_._._...._......._._�._._._._.__._...._._._._._._.__...._...._._._.....$15 5 .0 0 f or f i rs t
$10, 000 .00 plus $1.00 per $100 .00 valuation or part thereof
Over $2 5,0 0 0.0 0._.__._._._._.w....._._._._._......._...._._.............�...._._._._._.........._...._...__...._._..$3 0 5.0 0 p lus $0.5 0
per $100 .00 valuation or part thereof .
� Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100 .00 plus the normal permit fee, which ever is
greater.
. ' . .
.
� � c�yaraan��
� Oiv�Sion of Inspq�twn Sen•kcs
215 CT��eh A�•�ue
PC�E1w i!JU
'r'�, ,/� � Cchw�xn wi�evo�.i i�u
`�'���./J H OtNee 920.:�a5U�r:
'9N�n�YI�T(O F�LC '��U.��6-_IIAJ � . . -
Ele�tric I�stallation v�rification
;u tw�� �N�I ����-�� �
�L�`�.� C.:� - � �c.^
{Electrical Cori�ractor?lariic) � "-�"'
� �0(� ���Y�.R-� �C.:1�.�t 1C-�ttrJA � ' J�.4 � �,''�
(Addxess) -----�...�--�___..
(C1tY} (StaiC) {7ip t`.ode.7
have been contracted to p�rform electric insta�lation wvrk for .M�K. `--4�(-I N(,--�k �1 j( 1 t�,(
{Narae of pany contracted to)
at the followiag address: �Ll� � ���1`�:L'I�� •�12� . � � �(�S}-� � O ��,j� : ( i
.�.__ ....,
(Address whete work will b�perfor,fied) -
']'he nature of the wor4c consists of: (Check On�arDescribe the Nature.af Work}
� Reconn�ction or r�ew.c�rcuit for replacci�nerit Heating Plau.t�at�dlor A/C Condensex�. -
Recvrutiection or ne,�v�ir�uit for;�ep�.acsmeut E;ectric Watet�l�eatez.
Recannectioa of the Se�i�vice Ent�aiice�able,Metar Box, alfarations to tecept��t es and
li$hting fixtures'due to sidiiig%.soflit installari4n: Nota: N�w Service Entr�nce
Cabies will require a:separatepe'rrarit. � �
Recaruaection or aew circuit,for ot�er pernnarlcntty wir�d appliances I Tixtures.
.� 4ther .
-- -----� .
r__._�.. � �
Thc value of t}�is work is $ �aS,�?p
I hereb�►verify this�wark will be parfa�c� by��n'ca�pieyee Qf this cvmpau��a�d�f�rther verify the
reconnection 1 insta���tion will be t�o��iri comp'liaace with manufacturer:�d Electric c�de
requinem�ats. .. . .
� , . . . . . .
� • . . � • ��_���
(Si�ature parly�fficer) � � � (Pi�ii�'tNamc of 'cer) (I1ate)
10/02/00 btON 09:36 CTS/RII NO 7820]