HomeMy WebLinkAbout0102525 HOSHKOSH
ON THE WATER
.lob Address 182 W 21ST AVE
Contractor MCM AIR INC
Fuel ~J Gas
System ~J New
~J Forced Air
~J Electric
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Radiant
Hot Water
Owner SCOTT J OLSON
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
102525
06/30/2003
Other J
Vent J
Use/Nature SFR/Install 2 ton 24m btu A/C. *EIV form from Seckar Electric.
of Work
Fees: Valuation
Issued By:
$1,900.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$33.50
Date 06/30/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 6122 COUNTY ROAD M WINNECONNE WI 54986 -9780 Telephone Number
(920) 582-4402
City of Oshkosh , ~,~: ~, ,~
Division of Inspection Services % ~i~.~?'-'~ ,~, /~~
P.O. ~x 1130
Os~os~ ~ 54~3-1130 %~ ~~
Pho~ (920) 23~SOS0
HVAC PE"MIT
~co~le~ a~hcago~ ~ ~t ~ ~~ ~/
· A~li~(s) ~d fe~s) ~ be ~ou~t m Ci~ Hall, R~m 20S or ~ m ~~ ~',~ Box 1128,
Os~osh ~ S4903-1128; Co~c~ wink ~out ~t(s) ~1] ~t ~ f~s ~ do~bled or $1~.~ pl~
noel ~t fee, w~ch cv~ is ~t~.
OR
I[ you are a contractor ~artic~attn~ in the ~ermit ~ee ~ccount System and ~ave adequate ~unds. check herq
if you want this ~rocessed through your account ~
CONTRACTOR MCM AIR, INC. 6122 COUNTY RD M, WINNECONNE, WI 54986
5.82-4402 FAX 582-013.6
CHF~CK li~ ALL APPLICABLE
USE CATEGORY
I~ingle Family I-IDuplcx
I-IMulti-Family
ClRental I-ICommercial I"llndustrial
FUEL I~Gas nElectric EiSolid SYSTEM ONew C]R~lace
EiOil EiSolar C]Othar'~ad, A / ~ "'
TYPE
VIForccdAir EiRadiant I-iStearn ~A/C EiVent EiElectric r'lHotWater nSuppl. EICon. Burner
IS CHIMNEY BEING LINED I~No nYes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFA~
CHIM~Y TYPE EiChirnncy A EiChirrm~y B EiDirect Vent OOther
HEAT LOSS nAs Approved I-IExisting I-INot Applicable
BTU RATE I-lAs Per Plan EiVariable EIOther Value
DESCRIPTION OF ALL WORK BEING DONE ~_..~ g~Cl l'l
VALUE (Including labor and all'materials including light fixtures) $ I ,C~ ~, ~ .........
ELECTRICAL CONTRACTOR ~ ~{~ ~ ~[~ O_~ .
Jig~or applicable projects, an Electric Installation Verification form, signed by the Elcctr{cal Contractor, must be
at~chcd. If not attached or no~ applicable, a separate Electrical Pe~-u,lt is required.
9/02
C}Jldtmb W] S4~02.1 ]~,o
Electric Installation Verification
O~tectric~l Contractor Name)
('Nlmc of pert7 ~n~d to)
(Ad~ w~ work ~ b. p~~)
TI~ nature of the work consists of'. (.Check One or Descn'be th= Nature of Work)
Reoormeolion or new circuit for rophoement Heafin8 Phnt ~or ~C C~~.
~ecfion or n~ c~t for ~l~t Blw~c Water H~ or ~w~ v~ted
, R~~ of~c S~ ~~ ~1~ M~r ~x, ~~s ~ ~cl~
~d Ii~g fix~ duc to signs / ~t i~l~on. Note: N~ S~
En~e C~les ~ ~q~e a ~e ~t.
~~on or n~ c~dt for ~ r~~t of o~ p~~y ~
~p~c~ / ~.
N~ ~t for ~e ~fi~ of ~C ~ ~ i~vi~a/~di~ ~ ~ or ~e
in~vi~ s~t~s ~ a dupl~ or ~do~), ~g ~ s~ce
eteo~o~ o~e~.
TI~ valuo o£this work is $~.
I hereby verify ~ work will. be performed by an employee of this company ~nd fur&er verify
the recom~oction / inStallation will be dono in compliano8 wiRt manu~cturer and Electric code
(S'i~urefof Company Officer)
(Print Name of Of/lc=) ~a~¢)