HomeMy WebLinkAbout0102397-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
.lob Address 1739 ARIZONA 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 CHAD S T BOETTCHER/MELISSA J
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
102397
06/16/2003
Other
Vent J
Use/Nature SFR/Replace 80m btu furnace and add 2 ton central air. *EIV form from Hoehne Electric.
of Work
Fees: Valuation
Issued By:
$4,200.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$68.00
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
City of Oshkecsh
Division of Inspection Services
P.O. Box 1130
Oshkosh, 'CCI 54903-1130
Phone (920) 236~5050
Fax (920) 236-5084
RECEWED
DEPARTE ENT OF
All information after bold categories must be provided.
Incomplete applications will not be processed.
O/HKO/I-q
ON THE WATER
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 your account ~]
JOB ADDRESS
CONTRACTOR
CHECK [] ALL APPLICABLE
USE CATEGORY
· x,J~ingle Family ElDuplex
I-IMulti-Family
I-1Rental ElCommercial l-llndustrial
FUEL J~4as F1Electric UlSolid SYSTEM DNew l~I~eplace
mOil [] Solar []Other
orcedAir [3Radiant []Steam []A/C [3Vent [3Electric F'lHot Water []Con. Burner
[3Suppl.
IS CHIMNEY BEING LINED F1No []Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being xented.
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS
BTU RATE
[]Chimney A ElChimney B "~'f)irect Vent BOther
[3As Approved F1Existing nNot Applicable
l-lAs Per Plan F1Variable BOther Value
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all materials in¢ifng~tfxtures) $
[] For applicable projects, an Eleo/tric'Installation Verification
attached.
form, signed by the Electrical Contractor, must be
If not attached or not applicable, a separate Electrical Permit is required.
9/02
Electric installation Verification
(We)
(Electrical Contractor Name)
(Ad,ess) (Civy) (State), (Zip Code)
have been contracted to perform electric installation work for __~~:a~ ~
(Name of party contracl~l to).
The nature of the work consists of: (Check One or Describe the Nature of Work)
~ Reconnection or new cimuit for replacement Heating Plant and/or A/C Condenser.
Re. connection 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 I soffit installation. Note: New Service
Entrance, Cables will requi~ a $~amte permit,
~ Reconnection or new circuit for the replacement of other permanently wired
nl:~pli~= l fixtures.
New circuit for the addition of A/C to an individual dwelling un~ (1-muse or the
individual systems in a duplex or condominium), inetuding required service
eleetrieal outlets.
Other
The value, oftUs work is
I hereby ~'~: work. Alt be p~Orm~ by an employee o£~s company and fut,&er verifY
the reconnection I installation will be done in comp~ance with manufacturer and Electric code
re~ents.
(Print Name of Officer)
(Date)
5/02