HomeMy WebLinkAbout0102157-HVAC (furnace & a/c)(~ CITY OF OSHKOSH No
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 436 HAWK ST Owner WILBERT E/RANDO MAYER JR
Contractor AMERICAN HEATING & A C CO Category 502- Residential-Both
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 O Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 75m & 24m a/c
Create Date
Plan
~J Solid
Vent
102157
06/12/2003
Use/Nature SFR/Replace furnace and add central a/c. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$4,000.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$65.00
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
~ity Of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
RECEIVE[I
JUN 12 oo30/HKO/H
HVAC PERMIT APPLICA I RIIIRTMENT OF
All information after bold categories
M I ¥dDEVELOPMENT
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
lf ¥ou are a contractor participating in the Permi~e_e~Acconnt Svstem and have adequate funds, check here
if you want this processed through your account
JOB ADDRESS ¢_.~
OWNER
CONTRACTOR
CHECK [] ALL APPLICABLE
USE CATEGORY
~[~ingle Family nDuplex F-1Multi-Family
glRental F-1Commercial nlndustrial
FUEL ~as [3Electric r-lSolid SYSTEM l-INew 'J~eplace
[2Oil E]Solar F1Other
TYPE
~l~orced Air Y'lRadiant [2Steam ~'VC [2Vent [2Electric DItot
Water
[2Suppl. U1Con.
Burner
IS CHIMNEY BEING LINED'~lqo D-lyes - LINER SIZE__
& MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE [2Chimney A [2Chimney B ,[~Direct Vent
HEAT LOSS [2As Approved ~xisting I-INot Applicable
BTU RATE [2As Per Plan [2Variable I~D. ther Value
DESCRIPTION OF ALL WORK BEING DONE .~/~v~---
VALUE (Including labor and all materials including light fixtures) $ M//t59OO ~
ELECTRICAL CONTRACTOR O. fl ~"~ectric Installation Verification form attached(If Replacement)
Elect~cal installation of new/replacement equipment shall be done by licensed contractors.
3/02
Electric Installation Verification
(El~c~ Con,actor N~e)
(Ad.ess) (City) (S~te) (Zip Code)
have been eon~aeted to peffo~ electric installation wo~ for ~/~ ~ ~& ,
~e ofp~y eon~e~ to)
at the following ad.ess: ~ff~ ~/~
(Ad.ess where work will ~ ~ffo~)
The nature of the work consists of.' (Check One or Describe the Nature of Work)
. ~/ Reconnection or new circuit for replaceraent Heating Plant and/or A/C Condenser.
Reconnecdon 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 in.q, allatiom Note: New Service
Entrance Cables will require a separate permit.
__ Reennnecfion or new cireuit for the replacement of other permanently wired
appliances / fixtures.
__ New circuit for the addition of A/C 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 recormection / installation will be done in compliance with manufactm'er and Electric code
requirements.
(Print Name of Officer)
(Date)