HomeMy WebLinkAbout2003-HVAC (A/C)OSHKOSH
ON THE WATER
,Job Address 2319 ABBEY AVE
Contractor TENTH STREET STATION INC
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner THOMAS E/AMY M GILBERTSON
Category 501 - Residential-Air Conditioning
Electric
Replace
Steam
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
102061
06/09/2003
Other J
Vent J
2 ton
Use/Nature SFR/Install new 2 ton a/c. *EIV form from Drexler Electric.
of Work
Fees: Valuation
Issued By:
$1,441.78 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$27.50
Date 06/09/2003
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 :T~NTH STR~T STATION, INC. FAX NO. :920-2~G-0150 Jun. 09 2003 07:03AM P2
City of Oshkosh
Division oflnsp~cfion Services
P.O. Box 1130
OshkOsh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
O/HKO-/'Fi
ON YH~ ',~^T~R
" 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 Iuspeoti°n Services, PO Box 1 ! 28,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fcc, which ever is greater.
OR
are g contractor Barticipatin~t in the Permit, fee Account Syst6m and have ad.equate .funds, check here
If y'.Cu~jr ¥o~ want th~s processed through your account
.,cHEcK IZ ALL APPLICABLE
USE CATEGORY
1EltSingl¢ Family [:]Duplex
ElMulti-Family r'lP,.ental
[3Gomm~rciaI
FUEL r'iGas l~Electric El$olid
~Oil VISolar
VIFor¢¢d Air ElRadiant ElSgam tl~C
SYSTEM
ElOther
I-IReplace
F1Vent l-lElectric r'lHot Water i'lSuppl. I-ICon. Burner
IS CHIMlgEY BEII~G LINED ~No ~Yes - LINER SIZE,
Notc: All chimneys shall bc sized p~r th~ BTU's being vented.
& MANUFACTUREK
CHIMNEY TYPE VIChimney A DChimney B ~Direct Vent g3Other
HEAT LOSS I-lAs Approved ~Existing I~Not Applicable
BTU RATE [NAs Per Plan nVariable ElOther Value Z~O/~,J
DESCRIPTION OF ALL WORK BEING DONE
' VALUE Onclndtng labor and all msteri~ls including Ii,hr fixtures) $ / z~ ~.~ 1,'~ ,t~
ELgcrmc c coN croR rte¥
~For applicable projects, an Electric Installation V~wification form, signc'd by the Elec~cal Contractor, must be
attached. If not attached or not applicable, a separate Eleclrical Permit is required.
FROM :TENTH STREET STATION, INC.
FAX NO. :920-236-01S0
.The value of'this work is $
Jun. 09 2003 07:02AM P1
Electric Installation Verification
(Electrical Conh2ctor Nam.c)
.,, (City). (State) '(Zip Code).
-' have been contracted to perform'electric installation Work for ~,J~'),J'~ STgO~-- ' ~
.. . (Name of party contracted to)
atthe followhiga&tress: ~3/,~t 0q-(~fl ~ ~ ..
(Address where work will be performed)
The nature 'of the Work consists of:..(Check One o~ Describe the Nature of. Work)
· ~ Rec0nnection or new circuit for replacement.Electric Water Heater or power vented
water heater,.
~. Reconnection of the Sen;ice Eatrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. 'Note: New Service
'. Enlrance Cables will require a separate peamit. '
- Reconnection or new 'circuit ,for the replacemm]t of other permanently wired
-.. New circuit for the addiiion of,adC t'o an individual dwelling 'unit (houSe 6r fl~e
individual syst~ns in. a duplex or condominium), including required service.
elevtrieal outlets. . '. ' . .
Other
I hereby verify'this work will be performed by an employee oft, his company and further'verify
the'recormeetion / ins~allation will be done in compliance With manufacturer and Electric code
· requirements,
(Date)
p y Officer)
(Pnnt Name of Office],)