HomeMy WebLinkAbout0101775-HVAC (a/c)OSHKOSH
ON THE WATER
.lob Address 1705 WHITE SWAN DR
Contractor RASMUSSEN'S HEATING & A/C 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 MARKA H SWIECA/RUSSELL L FIC
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ Chimney B
Heat Loss I~ As Approved O Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
101775
05/28/2003
Other J
Vent J
2 ton
Use/Nature SFR/Replace two A/Cs. *EIV form from Slim's Electric.
of Work
Fees: Valuation
Issued By:
$8,218.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$129.50
Date 05/28/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 5154 DAVID DR OSHKOSH WI 54904 -8850 Telephone Number
920-235-6569
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 TH~ WATER
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
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 .~, -~
CONTRACTOR
CFIli:CK [] ALL APPLICABLE
U_U~E CATEGORY
~Single Family I"IDuplex nMulti-Family F1Rental
F1Commercial
[]Industrial
FUEL ~Gas FIElectric FISolid SYSTEM F1New ~eplace
FIOil F1Solar I-IOther
E
~Folrced Air ElRadiant ClSteam ~C I-IVent UlElectric EIHot Water I-lSuppl.
IS CRIMI~Y BEING LINED g~No r'lYes - LINER SIZE & MANUFAC~
Note: All chimeys shall be sized per the BTU's being vented.
cm'MNEY TYPE FIChinmey A ~~.~y B t Vent FlOther
lql~.AT LOSS I-lAs Approved ~_.,l~lot Applicable ,
BTU RATE nAs Per Plan 121Variable ~Othcr Value ~ ~-D~ $
FlCon. Burner
DESCRIPTION OF ALL WORK BEING DONE
VALUE (including labor and all materials including Hght fixtures) * ~2/8. O O
ELECTRICAL CONTRACTOR '~ t,'~ ~3 ~f/¢,:.d-r ~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.
Electric Installation Verification
I Cwo)
(~~ Contractor N~me)
(Addrmm) ' (City) (State) (Zip Code)
have be~n contracted to perform electric installation work for
(Name of party contracted to)
'"
The nature of the work consists of:
(Ch~k One or D~crib~ the N~'um of Work)
,, Recomection or new circuit far replaoement Electrio Water Heater or power vented
water heater.
Reconnecflon of the S~.ce Fzmance Cable, Me, er Box, alterations to receptacles.
ami lighting fixtures dne to siding/~offit immR~on. Note: New Service
Entrance Cables will require a separat~ permit
Reommeotion or new oirouit for the replacement of other permanently wired
~ ~it fm fl~. addilio~ of AlC to an ~~ um/t (house orthe
eleciri~ outlets~
The yalue of this work is $
I hereby verify this work will be perfonn~ by an cmplo~ of figs company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code