HomeMy WebLinkAbout0102158-HVAC (a/c)(~ CITY OF OSHKOSH No
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
JobAddress 1933 MONTANA ST Owner ARTHUR BLOESL
Contractor AMERICAN HEATING & A C CO Category 501 - Residential-Air Conditioning
Fuel ~J Gas ~ ~J Oil b~ Electric ~J Solar
System ~J New ~ ~J Replace ~ ~J Other
~J Forced Air I ~J Radiant L~ Steam ~J A/C
~J Electric I ~J Hot Water b~ suppl. ~J Con. Burner
Chimney Type I~ Chimney A ~ Chimney B ~ Direct Vent O Not Applicable I
Heat Loss I~ As Approved ~ Existing O Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 24m btu a/c
Create Date
Plan
~J Solid
Vent
102158
06/12/2003
Use/Nature SFR/Install 2 ton central a/c with air handler. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$3,200.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$53.00
Date 06/12/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1129 MICHIGAN AVE OSHKOSH WI 54902 -6437 Telephone Number
(920) 235-8090
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
RECEIVED
JUN 1 2 2_005
HVAC PE RltEII.g j l .l
All information after
Incomplete applications will not be processed.
O/HKO/H
ON TU~: \,VA'f FR
· 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 ~vithout permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
I~_¥ou are a contractor participatin.~ in the Permit fee Accoun_t System and have adequate funds, check here
if you want this processed through your account [-]
DATE
CHECK ~l ALL APPLICABLE
USE CATEGORY
~ingle Family IZlDuplex
F-IMulti-Family
I--1Rental F1Commercial Fllndustrial
FUEL F1Gas F'lElectric [DSolid SYSTEM ,,~lew
[Z]Oil I-]Solar E1Other
FIReplace
TYPE
FlForced Air FIRadiant F1Steam,~C U]Vent U1Electric F1Hot Water U1Suppl. F-ICon. Burner
IS CHIMNEY BEING LINED~No UIYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE FqChimney A FIChimney B F!Direct Vent UIOther
HEAT LOSS I-lAs Approved F1Existing [~ot Applicable
BTU RATE IDAs Per Plan UIVariable )~lOther Value
DESCRIPTION OF ALL WORK BEING DONE ~.5' f/T// ~
/,-',
VALUE (Including labor and all materials including light fixtures) $._.~.~0 ~
ELECTRICAL CONTRACTOR
OR ~-,Eiectric Installation Verification form attached(If Replacement)
Electrical installation of new/replacement equ(t)ment shall be done by licensed contractors.
3/02
Cfly of
Division of lng-etlon Services
215 C~h
~ WI 54903-H30
0~
Fax 92~23~50~
Electric Installation Verification
(Electrical Contractor Name)
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for/~:,fi2~/C-A'-~ [~t--~ A_/(_~ ,
(Nme of party contracted to)
at the following address:
(Address where work will be performed)
The nature of the work consists of:
(Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Recormection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reconnection or new circuit for the replacement of other permanently wired
appliances / fixtures.
New circuit for the addition of MC to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
requirements.
-(Signatm~e of Company Officer)
(Print Name of Officer)
(Date)
5/02