HomeMy WebLinkAbout0101615-HVAC (a/c)OSHKOSH
ON THE WATER
.lob Address 1634WESTERN ST
Contractor TENTH STREET STATION INC
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner AUSTIN T MOORE
Category 501 - Residential-Air Conditioning
Electric
Replace
L~ Steam
L~ 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
101615
05/19/2003
Other
Vent J
2 ton
Use/Nature SFR/Install new A/C. *EIV form from Drexler Electric.
of Work
Fees: Valuation
Issued By:
$1,440.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$27.50
Date 05/19/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 924 OHIO STREET OSHKOSH WI 54902 -0
Telephone Number
236-8770
FROM
:TENTH STREET STATION, INC. FAX NO. :g20-236-0150 Mag. lg 2003 07:58AM P1
City of Oshkosh
Division o£ Inspection Services
P.O. Box ] 130
Oshkosh, WI 54903-1130
Phone (920) 236-$050
· Fax (920) 236-5084
" HVAC PERMIT APPLICATION
All information after bold categories mu~t be pzov/ded.
Incomplete applications will not be processed.
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspe°tion Services, PO Box I 128,
Oshkosh WI' 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus hhe
normal permit fcc, which ever is greater.
OR
1£ you are_ a contractor participatin~ .in the permit fee ~cc, ou, nt System and have ~dequate funds, check her.
if~vo~ want this procersed throu~:h, your.a~count _[~ '
CIIECK gl ALL APPLICABLE
EIDuplex DMulfi~Family F1Remal
USE CATEGORY
~i~3ingl¢ Family
DCommercial Oludustrial
FUEL OGas I~l~le~tric 'OSolid SYSTEM e]~ r EIReplace
ElOil EJSolar ' ~Oth ~r
TYPE '
l]Forccd Air CIRadiant
ElSteam I~AJC. OV~nt OEleclric
IS C'~r~V BI[INa LII~O I~No OYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
Elliot Water F1Suppl. FICon. Burner
& MANIYFAC'TUR.ER
Cm'MNEY TYPE ClChirtmey A OChinmey B I-IDirect Vent ~other
HEAT LOSS OAs Approved IElExisting ~'Not Applicable
BTU RATE EIAs P~r Plan nVariabic [i~O~h~r Value _ _Z~ ~
". VALUi~ (Including labor and ail materials including light fixtures)
g For appli,able projects, an Electric Installation Verification form, signed by ~e Electrical Conlractor,' must be
· attach,d. 'If not attached or not applicable, a separate Electrical Permit is required.
9/02:
FROM :TENTH STREET STATION. INC. FAX NO. :920-236-0150 May. 19 2~3 07:59AM P2
Electric Installation Verification
have ~ ~~ to p~o~ electro ~la~ion w~ ~~
et ~o follo~n8 ~ I [ ~ ~ ~C~
(Add~s wh~ work will bo
_~ Rem~fion or n~ dmffit for r~lac~t ~ng
R~ion or n~ dm~t for ~l~ement
- gl~tfic W~ Hcatw or ~w~ vmt~d
~ R~~ of~c Sc~ g~nce ~ble. ~ct~ ~'
~ ~l~g fmlurcs duc ~o sid~ / ~ffit ~la~on. Note; ~ S~ice
~ ~s will r~giM 8 sep~c
..... ~. ~~ ~ new C~uir for ~, ~1~ of~ po~t~
~ Hew c~uit f~ the ad~ti~ of~C ~ ~ individ~l ~lltng ~lt
, _ ~
The .valu,'o£ this work ii $__] ~ ·
I hmuby verify this work will l)e performed by m employee of this ~oml)any and fm'ther verify
thc reconnegdon / inl~allnlion will b, don~ in complianc~ with m&'auhettm~ &nd Elco-lc
rccluirements.
($i~nature6fCompany Officer)---
(Print Name ot Officer)