HomeMy WebLinkAbout0104582-HVAC (furnace)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/HKO/H
· 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
I£¥ou are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed through your account [~
JOS
CONTRACTOR
DATE
CItECK [] ALL APPLICABLE
USE CATEGORY
nSingle Family ~Duplex F1Multi-Family
FIRental E]Commercial nlndustrial
FUEL r-IGas r-lElectric FISolid
nOil r-ISolar
TYPE
J~Forced Air DRadiant F1Steam nA/C E]Vent [2]Electric
IS CIILMNEy BEING LINED nNo r-lyes . LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
SYSTEM nNew /,~Replace
F1Other
FlHot Water F1Suppl. nCon. Burner
& MANUFACTURER
CHIMNEY TYPE
HEAT LOSS l~As Approved [DExisting ElNot Applicable
BTU RATE nAs Per Plan DVariable [3Other Value
DESCRIPTION OF ALL WORK BEING DONE ,q/~ ~ -('",~ r ,.,?,~ c ~-
nChimney A [2]Chimney B ElDirect Vent FIOther
VALUE (Including labor and aH materials including light fixtures) $
ELECTRICAL CONTRACTOR//~C (o C dfd r~-Jr,
[] For applicable projects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02
O/HKO/H
City of Oshkosh
Division of Inspectlon Services
215 C]mrch Avenue
PO Box l l 3 0
(We)
Electric Installation Verification
(Electrical Contractor Name)
(Address) (City) (State)
have been contracted to perform electric installation work for
at the following address:
(Zip
(Nme of party contracted to)
(Address where work will be p~r~ormed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
/~ Recormection or new circuit for replacem or A/C Condenser.
Reconnection or new circuit for replacement E~Z't'ric Water Heater or powm' vented
water heat~.
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
Thevalueofthisworki.s~~ ~_~ ~
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.
(S 'i~~any Offi
c er)
lcer)
(Date)
5/02