HomeMy WebLinkAbout0090632-HVAC (furnace) �
V � CITY OF OSHKOSH No 90632
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OSHKOSH HVAC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 709 E NEW YORK AVE Owner JACQUELINE A HUBERTY Create Date 10/18/2001
Contractor RASMUSSEN'S HEATING&A/C INC Category 500-Residential-Heating&Ventilating Plan
Fuel ✓ Gas Oil Electric , , Solar Solid �
System � New �� � Replace �' Other �
✓ Forced Air� Radiant Steam A/C Vent �
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Electric Hot Water Suppl. Con. Burner `
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 60m
Use/Nature FR/Replace furnace. *Received EIV form from homeowner.
of Work
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Fees: Valuation $3,800.00 Plan Approval $0.00 Permit Fee Paid $62.00
Issued By: � Date 10/18/2001 '
� Permit Voided �I
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
AgenUOwner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number 920-235-6569
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� Divisian of Inspectioa Services
� � 215 Church Aveaue
p,p. Hox 1130
� pghkpsh, WZ 54903-1130
�!�� � '! Fax � (920) 236-5069
o~�..��""Ee Phone (920) 236-504B
HVAC PERMIT APPLICATION
All fields/information after bold categories must be provided.
Incomplete applications will not be processed.
DAT$ %U�`IrI'0� ?
JOB ADDRl3SS 7C�� L�, NC.w Yorlc
OWNBR �o,c..4��c. N bG'dy '
CONTRACTOR �is.sr'�,�sSLr�+S ��/A�..
CIRCLS ALL APPLICABL}3
IISB CATLG�RY SINGLE FAMI7 DUPLEX MULTI-FAMILY COMMERCIAL INDUSTRIAL
gIIgI, � OIL ELECTRIC SOLAR SOLID
SYSTEM NEW EPLACE OTHER
TypB FORCED AIR RADIANT STEAM A/C VENT
ELECTRIC HOT WATER SUPPL. CON. BURNER
IS CHI1�Il�7EY BBING LINED iUo LINER SIZE `-' MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPS CHIMNEY A CHINII�TEY DIRECT VENT OTHER
HSAT LOSS AS APPROVED NOT APPLICABLE
BTII R.AT$ AS PER PLAN VARIABLE OTHER VALUE (di�'O
NATUR}3 OF WORK: ��„� �urn�-�-�
VALIIB (Including l.abor and materials) $ �$!30
ELECTRICAL CONTRACTOR !�"`*.• � _, �OVNG Ow h G�
Electrical installation of new/replaeement equipment shall be done by licensed
contractors.
Valuation Fees
$0 t o $1, 0 0 0.0 0._...._.........._ _........_.........._._..._.........._..._�.._.......__......._...._._...».._..$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 irs t
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10, 0 0 0.01 t o $2 5,0 0 0.0 0.._._.......__..._.___._._._____..._.____..w......__......_.__._...-..--.-.-.$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 ......_...._._ ._._................_.__._.......____.__..�......_____........_...........$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 $100.00 p�us the normal permit fee, which ever is
Jun Z1 O1 09:40a Code Enforcesent 920-236-508# p. i
, . .
� ciry otEkhima6
� DivisioaoflmpedionServlec3
215 CiluCh Avcoue
PO Ba�1130
Oshfao:h Wl Ss9os•u30
tN6oe 920-236-5060
�'� Fnc 920-?365084
Electric Znstallation Verificataon
��VVC� :�CtG�'G�G N�14 t r�y
(print homeowner(s)name}
ti�e�homeowner(s)of 70 9 E. /�cw �urk
{address where work is to be performed)
accept the re.4ponsibility for performing the eledrical work as stated below for the property listed
above.
The nature of the work consists of: (Check One or Describe t6e Nature of Work}
✓ Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnecrion or new circuit for replacement Electric Water Heater.
Reconnection of the Service Entrane�Cable,Meter Box,alterations to m.ceptacles ;
and lighting fixttues due to siding/soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reconnection or new circ�rit for other permanently wired appliances/fxtures.
Other
The value of ttus work is$_ /o2U•�'�
I hereby verify this work will be perfom�ed by me and further verify the reconnection/ �
installation wilt be done in compli�nce with manufacturer and Electric code requirements.
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;
_,_ (t� �lQ _ o f
H eowner(s)Signature ��) ;