HomeMy WebLinkAbout0102312-HVAC (a/c)OSHKOSH
ON THE WATER
.lob Address 624 W 11TH AVE
Contractor RIPON SHEET METAL
Fuel
System
Gas J ~J Oil
New ~
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner HERMAN B LEITZ
Category 501 - Residential-Air Conditioning
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
102312
06/19/2003
Other J
Vent J
Use/Nature SFR/Installing central air conditioning.
of Work
Fees: Valuation
Issued By:
$1,665.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$30.50
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 603 N STANTON / PO BOX 436 RIPON WI 54971 - 436 Telephone Number
1-800-236-2498
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-I 130
Phone (920) 236-5050
Fax (920) 236-5084
ON T-4F WATER
HVAC PERMIT APPLICATION
All information after 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 5490%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 [~
JOB a)D SS
OWNER gCam
CONTRACTOR
DATE & - t '7- tD.'~
CItECK [] ALL APPLICABLE
USE CATEGORY
~[,Single Family [-1Duplex
FlMulti-Family
[DRental I-1Commercial I'-1 Industrial
FUEL [3Gas EIElectric F'lSolid SYSTEM ~ew DR.eplace
[2Oil [3Solar F1Other
TYPE
I-1Forced Air [2Radiant F1Steam'IR~A/C I-1Vent [3Electric l-IHot Water [3Suppl.[3Con. Burner
IS CHIMNEY BEING LINED [2No F'lYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CHIMNEY TYPE
HEATLOSS
BTU RATE
I-1Chimney A
I-lAs Approved
[2As Per Plan
I-1Chimney B
[3Existing
[2Variable
[2Direct Vent
[3Not Applicable
F1Other Value
[2Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials including light fixtures) $ /) 6 d k_~,. D ~D
ELECTRICAL CONTRACTOR
j p J/Y G
OR [3 Electric Installation Verification form attached(IfReplacemem)
Electrical installation of new~replacement equipment shall be done by licensed contractors.
3/02