HomeMy WebLinkAbout0102473-HVAC (a/c)OSHKOSH
ON THE WATER
,Job Address 2355 W 9TH AVE
Contractor
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
GRANT SCHULTZ HEATING & COOLING
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner ARCHANGEL CONG ST RAPHAEL THE
Category 501 - Residential-Air Conditioning
Electric
Replace
Steam
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
102473
06/27/2003
Other J
Vent J
Use/Nature CONVENT/Install new A/C. *EIV form from Drexler Electric.
of Work
Fees: Valuation
Issued By:
$1,310.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$26.00
Date 06/27/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1411 S MAIN ST Oshkosh WI 54902 - 6519 Telephone Number
(920) 216-1616
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903~1130
Phone (920) 236-5050
Fax (920) 236-5084
HVAC PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
.O, ZHKO./H
ON THE
· 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) wilt result in fees being doubled or $1.00.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor ~artici~_atin~c in the Permit fee ,4ccount System and have adequatq funds~ check here
if yOu. want. this processed through your account
JOB ADDRESS
OWNER 54.
CONTRACTOR
DATE
JUN 1 7 2003
CHECK I~ ALL APPLICABLE
USE CATEGORY
~Singte Family UIDuplex
IDMulti-Family r"lRental
.. DEPART IENTOF
nc°m l [:g MIJ N I Et PIVIENT
FUEL F1Gas F1Electric FISolid SYSTEM ~JNew . FIReplace
UIOil r-ISolar f-IOther
gPE
orced Air FIRadiant F1Steam I-IA/C r-lVent FIEiectric r'lHot Water FtSuppt.DCon. Burner
IS CHIMNEY BEING LINED CINo FIYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented,
& MANUFACTURER
CHIMNEY TYPE I-IChinmey A [2Chimey B F1Direct Vent
HEAT LOSS r'tAs Approved 7qExisting F1Not Applicable '
BTU RATE I-lAs Per Plan inVariable I-IOther Valu.c
DOther
VALUE (Including labor and all materials including light fixtures) $ I ~ i 0. ~
]~LECTRICAL CONTRACTOR C~fe.~, ltf~r''' OR [] Electric Installation Verification form attached(IfReptacemem)
£lectt~cal installation of newlrepbtcement equipment shall be done by licensed contractors.
I'd
6C~Gi~-LC;~(O~S) O/O · ~:~H z:~Inqos
3/02
~SC:LO 60 LI un['
~, Jun~l? 03 O?:~Sa ~ Grant SchuItz HtC & R/C (920)23?-4959 p.2
(We)
Electric Installation Verification
(Addres§)
(Electrical Contractor Nmn¢)
(City)
have been contracted to perfmra electric installation work for
at the followbg address:
(State) (Zip Code)
(Name of party contracted to)
The nature of the work consists of:
(Adckess where worlc will be performed)
(Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating ?lant m~d/or A/C Condenser.
Reconnection or new circuit for repIacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alteratimm to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Se~wice
Entrance Cables will require a separate pemfit.
Reconnect/on or new cimuit for the replacement of other permanently wired
appliances / fixtmees.
New circuit for the addition of)dC to an individual dwelling unit (house or tim
individmal systems in a duplex or condomimum), h~cluding required service
electricaI outlets.
Other
The value of this work is $ /.3-.o. c. JO
I hereby verify this work will be performed by an employee of this company m~d further veil ,fy
the reconnection / installation will be done in compliance w/th manufacturer and Electric code
requirements.
p y )
(Print Name o f O£fiee0 ' (Date)
5/02