HomeMy WebLinkAbout0102396-HVAC (boiler replacement)OSHKOSH
ON THE WATER
.lob Address 2505 OREGON ST
Contractor CUSTOM HEATING & COOLING
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner MAURO/CYNTHIA MARTINEZ
Category 510 - Ind. & Comm-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type IO 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
102396
06/16/2003
Other
Vent J
Use/Nature COMM/Mario's Place/Install 175m btu boiler replacement. *EIV form from Hoehne Electric.
of Work
Fees: Valuation
Issued By:
$6,000.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$95.00
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
Ci~ of Oshko.~h
Divisio~ of Inspection Semces
P.O. Box 1130
Oshkosh, WI 54903-1 ] 30
Phou~ (920) 236-5050
Fax (920) 236-50~4
RECEIVED
JUN I 6 ~:~..,~,~
DEPARTMENT OF
~O~'IUNITY DEVELOPMENT
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
Application(s) and fee(s) c~n be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh W! 54903-1128o Commencing work without permit(s) will result in f~s ~g doubled or $I00.00 plus the
no.al pe~t fee~ wMch ev~ is ~eater.
OR
CONT~OR ~
CHECK ~t ALL APPLICABLE
:-./::': ,' ::~ . i' :':-:~:~ i':~ ': · ' "" ':' ' ' ~' ' ' ' : '
:DSingl¢:Fm.ily.:,:.,;: UDup!ex .. 12MUlfi:F~ily :: 12lReai'ai .... ~commer¢ia1
.FU~ .(;' ~"s -" ~El'c~c ~Sohd SYSTEM ~New ~place
....... ~Oil . ~Sol~ ~Oth~
ElForced Ai~ ElStearn [IMC rlVmt ElEtectric
IS CHIMNEY BEING LINE.No FIYes - L1NER SIZE
Note: All chimneys shall b. sized per the BTU's being vented.
CHIMNEY TYPE ~himney A DChirrmeY B
HEAT LOSS ~As Approved ClExisting"
BTU RATE EIA~ Per Plan ElVariable
~ot War~ V1SUppL lDCOn, Burner
& MANT.IFACTURER
ElDirect V.nt
IDNot Applicable
IZlOther Value
UlOther
DESCRIPTION OF ALL WORK BEING DONE
ELECT~C~CO~CTOR '::'~~'': , .'~/: '
,'~ PJor applicabi~ojects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
· ~Che'dl If not attached or not applicable, a separate Electrical perrmt is reqmred.
9/02
ON THE WATER
City of Oshkosh
Division of Inspection Se~wices
215 Church Avenue
PO Box 1130
Oshkosh WI 54903-1130
Office 920-236-5050
Fax 920-236-5084
Electric Installation Verification
(we)
(Address)
(Electrical Contractor Name)
(City)
have been contracted to perform electric installation work for
at the following address:
(State) (Zip Code)
of~alrty ~ -.
(Address where wor~ll be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
x~ Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection 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 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 $//.~ tyr,)
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.
(Signature of Company Officer)
(Print Name of Officer)
5/02