HomeMy WebLinkAbout0101880-HVAC (furnace; a/c)(~ CITY OF OSHKOSH No 101880
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 865 HERITAGE TRL Owner DARRELL M/ETHEL RASMUSSEN
Contractor TENTH STREET STATION INC Category 502- Residential-Both
Fuel ~J Gas ~ ~J Oil b~ Electric ~J Solar I L~ Solid
System ~J New ~ ~J Replace ~ ~J Other
~J Forced Air I ~J Radiant L~ Steam ~J A/C 1
~J Electric I ~J Hot Water L~ suppl. ~J Con. Burner 1
Chimney Type I~ Chimney A ~ Chimney B O Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value 0
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 75m heat & 2 ton a/c
Create Date 06/02/2003
Plan
Vent J
Use/Nature SFR/Replace furnace and a/c. *EIV form from Drexler Electric.
of Work
Fees: Valuation $3,200.00 Plan Approval $0.00 Permit Fee Paid $53.00
Issued By: Date 06/02/2003
Permit Voided J
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
FRON :~ENTH STREET STAT]ON,]HC.
FAX NO. :g20-~36-0150 Ma~. 29
City of Oshkosh
Division of Inspection Scrvice~
P.O. Box 1 I30
Oshkosh, WI 54903-1130
Phone (920) 236-$050
Fax (920) 236-5084
HVAC PERMIT APPLIGATION
All information after bold categories must be provided,
Incomplete applications will not be processed.
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed io Inspection Services, PO Box 1128~
Oshkosh W1 54903-1128. Commencing work without permit(s) will result ill fees beia$ doubled or $100.00 plus the
... not, al permit fee, which ever is greater.
, OR
If you are a contractor pa. cticipating in the. Permit f..e..~ ~4.ccount System and have bdeouate £ttnd$, check here
i£ vou want thJ~ra~es$_e_d.through your account .~
CHECK I~'ALL APPLICABLE
USE CATEGORY
~Sin. gle Family I-IDuplex
r'lMulfi-Family ~Rental FICommercial Il]industrial
FUEL l~as mElectric DSolid SYSTEM DNew ~Replaee
FIOil r'lSolar E]Other
TYPE
I~lForeed Air ClRadiant ClSteam ~A/C ~Vem ClElectric INHot Water
IZISuppl: ~Con, Burner
IS CH3MNEY BEING LINED ~No OYes - L~NER SIZE
Note: All chimneys shall be sized per the BTU's being vetoed.
& MANU~A~
C~iI~KNEY TYPE I'lChimuey A C]Chimney B [~"Direet vent OOther
HEAT LOSS r'IAs Approved [~fExistmg CINot Applicable
BTURATE nAsPerPlan F~Variable nOtherVslue '~;~ A~r~? Z~'~
VALUE (IJneluding labor and all materials including Dight fixtures) $ ~_.OO. ~
Lzcnu¢ co croR_
~For applicable proj~s, an Electric Installation Vvrification form, signed by-the Elec~rica! Con~r'actor, must be
a~ached. If not attached or not applicable, a scperate Elec~cal Pcrn~t ~s required.
~/02
FROM ~TENTH STREET STATION, INC.
FAX ND.
:920-236-0150
May. 29 2003 10:09AH P2
'.' , J ' ' ':": .... ' "':' "" ':i - ' ' ,' ~ '
..... Electric Installation Verification ,.,
(Electrical Contractor Nanle) ·
have been =n=cted lo p~o= elec~ic inst~lation work for ~W~ X~ S~:0'~"
.. (Addres~ where work will be ~o~)
" ~ R~o~ecfio~ or new c~c~t for r~lac~t ~]~c Wat~ Heat~ or Pow~ v~]t~
wat~ heat~. , .
~d ~[ fixers ~ue to ~idi~ I soffit/m/al]at/on. Note: New
' ~ Roco~e~on or new c~c~t for ~e ~placement of o~ p~cnay ~d
~.. -New circuit for ~e a~tion cftc to an individ~l dwelling unit (~e. or individ~ s~t~s in a duplex or con~mimum), ~c!u~g required
.....: The v/due oft. his work is.$' ~/_), ~ .
'; :' "'.i l~eby Verify ~Jais work will be p~fonned by an employee of this Company and further verify'
.-... the r¢¢mmection / installation will be done in compl!ance with manufacturer and Bleotric code
requirements.
(Print Name of Officer) (Date)
' 5~02