HomeMy WebLinkAbout0101726-HVAC (a/c)OSHKOSH
ON THE WATER
.lob Address 111-t 17 CIMARRON CT
Contractor BREWER HEATING
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Owner AM MOKLER PROPERTIES LLC
Category 501 - Residential-Air Conditioning
Fuel L~ Gas I [] Oil
System [] New j
L~-J Forced Air J LJ Radiant
LJ Electric I [] Hot Water
No 101726
Chimney Type
Heat Loss
BTU Rate
Use/Nature
of Work
Create Date 05~23~2003
Plan
b~ Electric / Ed Solar I b.d Solid
[] Be_Place ...... J E~.__ Other .....
L~ Steam j [] NC I LI Vent
[] Suppl. 1 [] Con. Burner I
h~ Chimney A O Chimney B O Direct Vent O Not Applicable I
~ AS Approved O Existing O Not Applicable I Value 0
L~- As Per Plan ~.~ Variable ~ Other J Value
Multi-Family / Install Air Conditioning* If ductwork is being done, plans would need to be submitted & approved prior to commencing work.
SEPARATE ELECTRIC PERMIT IS REQUIRED.
Fees: Valuation
Issued By: ~
$3,940.00 Plan Approval $0.00 Permit Fee Paid
[] Permit Voided J
$65.00
Date 05/23/2003
In the performance of. this work, I agree to perform all work pursuant to rules governing the described construction.
Signature ~.~ ~_~
Agent/Owner
Date
Address N8804 N DOUGLAS STREET RIPON WI 54971 - 0 Telephone Number (920)748-6494
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
O/HKO/H
ON THE WATFR
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
(f vou are a contractor participating in the Permit fee Account System and have ddequate funds, check here
(f you want this processed through your account ['~
DATE
Jos ///-//7
ClqE~CK [] ALL APPLICABLE
USE CATEGORY
mSingle Family F1Duplex
~ti-Family
F1Rental mCommercial r-llndustrial
FUEL
~as [:]Electric F1Solid SYSTEM :~q~ew FIReplace
FIOil FlSolar F1Other
TYPE
FiForced Air F1Radiant F1Steam FIA/C F1Vent F1Electric F1Hot Water F1Suppl. F1Con. Burner
IS CHIMNEY BEING LINED F1No []Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS
BTU RATE
[]Chimney A
F1As Approved
nAs Per Plan
[]Chimney B
[]Existing
nVariable
F1Direct Vent
FiNot Applicable
FIOther Value
[]Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR
[] For applicable projects, an E1/ectric 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