HomeMy WebLinkAbout0102302 HOSHKOSH
ON THE WATER
,Job Address 919 W NEW YORK AVE
Contractor ANDRESEN SHEET METAL
Fuel ~J Gas ~
System ~J New
~J Forced Air 1
~J Electric I
Chimney Type I~ ChimneyA
Heat Loss I~ As Approved
BTU Rate I~ As Per Plan
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Radiant
Hot Water
Owner JEFFERY A/MARIE SIEVERS
Category 501 - Residential-Air Conditioning
Electric
Replace
Steam
Suppl.
Solar
A/C
Con. Burner
Chimney B O Direct Vent ~ Not Applicable
Existing ~ Not Applicable
Variable ~ Other
Value
Value
No
Create Date
Plan
L~ Solid
102302
06/19/2003
Other
Vent J
3 ton a/c
Use/Nature SFR/New a/c add on. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$1,500.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$27.50
Date 06/19/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 2913 WITZEL AVE OSHKOSH WI 54904 -6539 Telephone Number
(920) 233-0323
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236.5084
RECEIVED
JUN
· DEPARTMENT OF
HVAC~ ~~.~I[~~N
All information ~ 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 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.
If.you are a contractor participating, in the Permit fee /lcOo.u..n~t Sy,*.tem .and have ad~_uate. :funds','"c'~e. ck h.¢re
~f you want th~s,~Pracessed throu~_ h you, r, account. ,~ ' .... '
DATE..
ow . CTf' ...................
C~CK li~ ALL APPLICABLE
ATEGORY
e Family EIDuplex [3Multi-Family [3Rental
[3Commercial ~Industriai
FUEL E~as [3Electric ElSolid SYSTEM ~h'q~'w ElReplacc
EIOil ElSolar [3Other
TYPE
~ced Air [3Radiant EIStenm ' 'Et~ EIVent [3Electric
IS CHIMNEY BEING LINED [3No [3Yes . LINER SIZE./~/~-
Note: All chimneys shall be sized per the BTU's b~ing vented.
[3Chimney A
rlAs Approved
r'lAs Per Plan
EIChinmey B
E1Existing
ElVariable
CIHMNEY TYPE
~AT LOSS
BTU RATE
DESCRII~ION OF ALL WORK BEING DONE,,
VALUE (Including labor and aH materials including light fixtures) $ / ~-~OO ' o 0
r. LECmCAL comaaACrOR, ~(~-~c~
El For applicable projects, an Electric Installation ~erificati0n form, signed by the EleC~cal C°ntractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
ElHot Water [3Suppl. [3Con. Burner
& MANI/FACTURER
FROM : SECKAR ELECTRIC
12 2002 09:54PM Pi
Electric lustaitafion Verification
O~d~m~) (City) (St:t~) {zil~ Code)
(Nax~¢ ofpar:y ~n~ted to)
(Ad.ss ~ work will b~ p~o~cd)
The maur~ of the work c~..~t~ of: (Caeck One or D~be ~ Na~e of W~l)
~~on or n~ ~rc~t for r~l~em~: ~c W~r He~ or ~w~ v~ted
~c~ C~lcs will ~e
~ N~ ~t for ~e a~ of~C tO ~ i~iduaf ~lli~ ~t ~ or the
......... Other