HomeMy WebLinkAbout0101800-HVAC (a/c) SHKOSH
ON THE WATER
.lob Address 2818 HOMESTEAD DR
Contractor MCM AIR INC
Fuel ~J Gas ~
System ~J New
~J Forced Air 1
~J Electric I
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Radiant
Hot Water
Owner JEFFREY & LISA BELLIN
Category 501 - Residential-Air Conditioning
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 O Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
101800
05/28/2003
Other J
Vent J
Use/Nature SFR/Install 2 ton 24m btu a/c. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$1,500.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$26.00
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 6122 COUNTY ROAD M WINNECONNE WI 54986 -9780 Telephone Number
(920) 582-4402
ity of Oshkosh
Division of Impection Services
P.O. Box 1130
Oshko~ WI ~4903-113O
Pl~m (92O) 236-5050
Fax (920) 236-5084
· Application(s) and fcc(s) can be brought to Ci~ Hall, l~om 205 or mailed to Inspccti~ Services, PO Box 1128,
Oshkosh WI 54903'1128. Commencing work without lxa'mit(s) will result in fees being doubled or $100.00 plus the
normal permit fcc, which cvcr is grcat~r.
OR
!f you are a contractor z~arttctt~atin~ in the'~ermti fee ,4ccount System and have'adeqUate funds, check her,.
If you want thts vrocessed through your account
CONTRACTOR MCM AIR, INC
CHlZ~CK ~ ALL APPLICABLE
6122 COUNTy RD M WINNECONNE, WI 54986
582-4402 FAX 582-0136
USE CATEGORY
29Single Family ~Duplcx
E2Multi-Family
r~Rc1~ta] rqCommel~a]
FUEL I~Gas OElcctric DSolid SYSTEM KXNew
Ooi OSol r OOthor Il
TYPE
EIForced Air . C]Radiant rISte~ ll/A/C 'r'lVent rlEleotri¢
IS CHIMNEY BEING LINED lRAlo EIY~ - LINER SIZE,
Note: All chimmcys sl~ll bc sized pcr the BTU's being vented.
CmMNEY TYPE
19'g~ AT LOSS
BTU RATE
EIChimn~ A
El.as Approved
I-lAs per Plan
r'lChinm~ B
[3Existing
Ii~Variabl¢
.El. Industri~
CIHotWator ElSuppl. riCoh. Burner
& MANUFACILIRER
· CIDireot Vent
ClNot Applicable
DESCRIFrlON OF ALL WORK BEING DONE Y VI ~"~o~ 11
nOt, her
VALUE (Including labor and all materials including fight flx~es) $ }.~ ~) 0
S ack
~.For ~pplicabl~ proj¢Ct~,' an £1¢¢~ Ir~l~tio~ V~rificatio~ form, ~ig~ed by th~ El~ical'Co~, mu~ be
· u~hcd. If.o~ ~tta~hcd or.o~ ~pplicabl¢, ~ ~-'parat~ Ele~cal ?crmit i~ r~quired.
~ ~ju~ O? 02 08~4~a - OShkosh [n;pmc~ons 8~0-236-$084
Electric Installation Verification
(Electrical Contra:tot Name)
(S=,¢)
~vo ~ ~~ to p~ elec~c ~a~on w~ for ~,
nature of~e work c~nsis~s of: (.Check One or Descn'be thz Nature of Work)
R. econnection or new ctrc~t for replacement Heagn~ Plant and/or A/C Conde3u~.
R. econneot~on or new circuit for replacement Electric Wa~er Heater or power vented
R.econnection of ~hc Service Euu'ance Cabl~, Meter Box, alterations to receptacles
~md lighting fixtm'os due to siding / soffit install~n. Note: New Service
Entrn~e Cables vAll require a separ~ l~.rmit.
Reconaecfion or new circuit for the replacement of other p~maneatly wired
New ~ for the nddition of A/C to an tndivid~l d,~v~llO~g ~n~t O,,ouse or the
individual sy~ems in a duplex or oondcrntim~), inoludi~.S required service
eleotri~al outlets.
The valu~ of this wozk is S_~. 0 0
I hereby ve~ this work will. be performed by an employee of{his company and further verify
the recom~oction / installa~ion wilt be done in compliance wkh manufacumer a.nd Electric code
r~quireram~.s.
(Print Nan~ of
5/02