HomeMy WebLinkAbout0101666-HVAC(a/c) CITY OF OSHKOSH
HVAC PERMIT -APPLICATION AND RECORD
OSHKOSH
ON THE WATER
Job Address 1313 FAIRVIEW ST
Contractor ADONIS HEATING AND COOLING Category 501 - Residential-Air Conditioning
Fuel [~ Gas I LJ Oil j L_.J Electric I L~ Solar
System [] New [ [] Replace
L-J Forced Air I L~ Radiant I bJ Steam I L~J A/C
LJ Electric I M Hot Water I LJ Suppl. I LJ Con. Burner I
Chimney Type ~.~ Chimney A ~ Chimney B ~ Direct Vent ~1~ Not Applicable
Heat Loss ~) AS Approved (~ Existing O Not Applicable [ Value
BTU Rate ~ AS Per Plan (...) Variable O Other I Value
Owner MR/MRS SAADAT MOUSSAVI
No 101666
Create Date 05/2112003
Plan
I ~1 Solid
_E~ Ot~e_r ...................
[] Vent
Use/Nature SFR/Install central air conditioning.* EIV from Seckar Electric attached.
of Work
Fees: Valuation $3,300.00 Plan Approval $0.00 Permit Fee Paid
Issued By: ~
$54.50
Date 05/21/2003
[]______JPermit Voided
In the performance,,' this w~k, I~,ee to p~~.~d-zm'f-td~.les goveming the described construction.
Signature //<"~'/~ ~ ~,,/~ Date
Address tW2707 County Rd H Pino River WI 54~5 - 0 Tolophone ~umber
685-0458
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
All information after bold categories must be provided.
Incomplete applications will not be processed.
O/HKO/H
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 you want this processed through your account ~]
DATE
JOB ADDRESS
OWNER
CONTRACTOR
B, loc, R VI
CI:W, CK [] ALL APPLICABLE
USE CATEGORY
~ingle Family FIDuplex
F1Multi-Family
F1Rental F1Commercial Fllndustrial
FUEL c;~as F1Electric
FiSolid
'" FiOil F1Solar
SYSTEM F1New FIReplace
FiOther
TYPE
FiForced Air FqRadiant F1Steam ,~C F1Vent FIElectric
(
IS CHIMNEY BEING LINED FINo FIYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
FiHot Water []Suppl.
& MANUFACTURER
FiCon. Burner
CHIMNEY TYPE
ltEAT LOSS
BTU RATE
[]Chimney A
F1As Approved
[]As Per Plan
[]Chimney B
[]Existing
[]Variable
F'lDirect Vent
F1Not Applicable
FiOther Value
[]Other
DESCRIPTIONOFALLWORKBEINGDONE / /-)S/~ [--~ C ~P-~[~C~ [/°r(t~ c/O/.;Oi SV/,d/~.26.--
VALUE (Including labor and a. materials including light fixtures) $ ~ ~ ~ 0'~ *
L CT JCaL CO T CTOa /- c
[] 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.
9/02
ON THE
City of Oshkosh
Division of Inspection serv~es
215 Church Avenue
PO Box 1130
Oshkosh WI 54903-I130
Office 920-236-5050
Fax 920-236-5084
Electric Installation Verification
(Electrical Contractor Name)
(Ad.ess) (City) (S~e) _ (Zip Code)
have been con~acted to perfo~ ~lecmc ~stallation work fo~ ~ ~ / & ~~ M ~ ,
~e ofp~y con~acted to)
at the following ad.ess:
(Ad.ess where work will be perfo~ed)
The nature of the work consists off (Check One or Describe the Nature of Work)
...... Recormection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection 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.
Necolmection or new circuit for the replacement of other permanently wired
appliances / fixtures. '
ew circuit for the addition of A/C to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $ [~-~- O~
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
C omp y 6m'c;r)
(Signature ~ '
(Print Name of Officer)
(Date)
5102