HomeMy WebLinkAbout0102395-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
.lob Address 1765 BRENTWOOD DR
Contractor CUSTOM HEATING & COOLING
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner MICHAEL M/JULIE TYRIVER
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ 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
102395
06/16/2003
Other
Vent J
Use/Nature SFR/Replace 80m btu furnace and add 2.5 ton central air. *EIV form from Hoehne Electric.
of Work
Fees: Valuation
Issued By:
$3,900.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$63.50
Date 06/24/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1503 SOUTH MAIN STREET OSHKOSH WI 54902 -0
Telephone Number
(920) 235-7263
City of Oskkosh
os os ,
Phone (920) 236-5050
Fax (920) 236-5084 "'
': JUN
I-IVAC P£RMIT APPLICATION
All information after bold categories must be providedOEPART~]l~,,r
Incomplete applicaii°ns will not be proces~0~/~UN,.~, '~'L~
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 pour account [~
ow .
CltECK RI ALL APPLICABLE
USE CATEGORY
· ~gle Family r-lDuplex
F-IMulti-Family
IZlRental
ElCommercial
IZllndustrial
FUEL ~tGas []Electric mSOtid SYSTEM
F1Oil l-ISolar
TYPE
X~orced Air F1Radiant F1Steam I-IA/C []Vent []Electric
IS CHIMNEY BEING LIN D)~lo I-lYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented
CHIMNEY TYPE
HEAT LOSS
BTU RATE
[]Chimney A
t-lAs Approved
r-lAs Per Plan
DESCRIPTION OF ALL WORK BE~~'E
[]New '-)S~eplace
[]Other
r']Hot Water r'lSuppl. []Con. Burner
& MANUFACTURER
I-tChimney B ,/~rect Vent []Other
F1Existing F1Not Applicable
[]Variable F1Other Value
(Including labor and all mater~l~fig li~,~ fixtures) $ cL--3?i~
VALUE
ELECTRICAL CONTRACTOR k~-v/. ~~
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
CUy of Oshkosh
Division of Insl~Clion
215 Chu~b
~ 1130
~e 925236-5050
Fax 9~236-~
I (we)
Electric Installation Verification
(Electrical Contractor Name)
(Address) (City)
(State) (Zip~Code)
have been contracted to perform electric installation work for ~O~ff/t4
(N~a~ o"~Party contracted to)-
(Address where work will be performed)
· ~tm'e of the work Consists of: (Check, One.or Describe the NatUre of Work)
.i., !:i:" Recormectaon or new ctrcmt for. replacement Heating Plant and/or A/C Condenser.
~ Reconnection or new circuit for replacement Electric Water Heater or power vented
:,.:. ,:3 ~..-~ec0~tig!:,.0f~e Service Entrance Cable, Meter Boxialterati0ns-t6}~/~:ci~s
".: ~ ~..... 'i~,: .': and lighting fixti~es due to siding /Soffit installati0n:"Note:' New 'Se~e
"Entrance Cables will require a separate permit.
__ Reconnection or new circuit for the replacement of other permanently wired
appliance~ / fixtures.
New circuit for the addition of A/C to an individual dwelling unit (house or the
individual systems in a duplex or condomimum), including required service
electrical outlets.
Other
The value of this work is ~'~. ~d
I hereby verify this work will be performed by an employee of this company and'further verify
the reconnecfion /ins~tallation will.be done, m eomplianeewithmanufaeture~ and Elect~c code
requirements. _ ,.....: :.: :
(Date)
5/02