HomeMy WebLinkAbout2003-HVAC (furnace)(~ CITY OF OSHKOSH
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 852 PROSPECT AVE Owner GERALDINE M ROELS
Contractor DRUCK'S PLBG & HTG & CLG Category 500 - Residential-Heating & Ventilating
Fuel ~J Gas J ~J Oil b~ Electric ~J Solar
System ~J New ~ ~J Replace ~ ~J Other
~ Forced Air I ~ Radiant L~ Steam ~ A/C
~J Electric I ~J Hot Water b~ suppl. ~J Con. Burner
Chimney Type IO Chimney A ~ Chimney B ~ Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable O Other I Value 40m btu
No
Create Date
Plan
~J Solid
Vent
102168
06/13/2003
Use/Nature SFR/ RENTAL/ Replace gas furnace. *EIV form from Heritage Electric.
of Work
Fees: Valuation
Issued By:
$3,247.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$54.50
Date 06/13/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 504 3RD ST P O BOX 355 MENASHA WI 54952 - 0
Telephone Number
(920) 426-2654
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
All information aftetob6tflt~hYd~b/-i~s ~nust 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
DATE
CONTRACTOR
CHECK [] ALL APPLICABLE
USE CATEGORY
[~rSingle Family F1Duplex
I-1Multi-Family
j~Rental []Commercial F'llndustrial
FUEL l~Gas F1Electric E]Solid SYSTEM F1New ,[~Replace
F1Oil F1Solar []Other
TYPE
JSIForced Air IZ1Radiant F1Steam FIA/C F1Vent []Electric FIHot Water []Suppl. FICon. Burner
IS CHIMNEY BEING LINED []No ~X/es - LINER SIZE P/"/ & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
ClxqMNEY TxX'PE [~Chilnney A 12]Chiw,ney B "F1Direct vent []Other
HEAT LOSS FqAs ApprOved I~Existing F1Not Applicable
BTU RATE I'lAs Per Plan []Variable F1Other Value fl'"~¢/~f~,~',,~/~'//''
DESCRIPTION OF ALL WORK BEING DONE
.~
VALUE (Including labor and all materials including light fixtures) $ ~/?.~/~ ff
ELECTRICAL CONTRACTOR/f/ff-/~.//~e~'~d;,f~E',OR [] ElectriC lnstallation Verification formattached(ifReplace~ment)
Electrical installation of new/replacement equipment shall be done by licensed contractors.
3/02
0~/12/2003 14:52 9207343838 HERITAGE
Jun ]~_ 08 03:0~p Oshkosh ][m~,peot. ions g2O-Z36-$084
PAGE 02
Electric lastallafion Verification
(E!ecmc~:.l Contractor NLm¢)
<^drifts) (City) (Stmt¢) (Zip Code)
h~vc be~n cor~'acted to lx,~£c,m) electric installation wor~ for
the following ~ess: _ ~<~2~/~C-~..'~>~.~~4
(Ad.ess where work ,~11 be p~rfo~ed)
The natu~ e£the wo:i~ ¢c. ns/*.ts of. (Check One or De,crib.-- rite Natur~ of Work)
Recovnecdov_ or new c, imuit lbr rep!~om~tt Hcatin~ Plmat
K~nnCcYion or n~w c~'~:~t for t~lacem~it E[~c v/~er Heater.
Restriction o'2'th= Se~='ice En~ce (,'.able. ~eter ~, mlt[~tio~s to receptacles ~d
lighting ~xmtcs Cue {o si~ug / ~ffit ~i!ation. Nora:
Cable~ wilt ~q'a~re a s~ate pe~t,
Recor, ncc~on or n~w circuit for other pe~cmly wired appli~ce~ ,"
Other
17., .....
l' hmcby verify this w~i'];.~w-i-llJoc-per~rmtrcl'b'~: an employee of~i$ company a~d further veri~ the
reco~mection / in~taLlauon.wiil t'~ eon,s-m-e~mpli~¢e Wi/h mari'~ac,'th-~r aad Eiectrtc-<ode
requireme~l{$.
(Prim Name of()ffi.~er)