HomeMy WebLinkAbout0104673-HVAC (furnace)OSHKOSH
ON THE WATER
.lob Address 846 W 12TH AVE
Contractor PALISADES SHEET METAL
Fuel
System
Gas J ~J Oil
New ~
Forced Air
Electric
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Radiant
Hot Water
Owner ELIZABETH M KLOS
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA
Heat Loss I~ As Approved
BTU Rate I~ As Per Plan
Chimney B ~) Direct Vent O Not Applicable I
~) Existing O Not Applicable I Value
~ Variable ~ Other I Value
No
Create Date
Plan
L~ Solid
104673
10/08/2003
Other J
Vent J
Use/Nature SFR/Install furnace.
of Work
Fees: Valuation
Issued By:
$2,400.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$41.00
Date 10/08/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 1475 RACINE ROAD MENASHA WI 54952 -0 Telephone Number
(920) 729-1282
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-I 130
Phone (920) 236-5050 ct(~ ~7'
Fax (920) 236-5084 ~,~ ~
· All information after bold categories must be pro~id~,~,
Incomplete applications will not be processed. ~
* Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspectio~S~e/~ces, 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 eve[ is g~eater.
OR
1£¥ou are a contractor participating in the Permit fee Account SFstem and have adequate funds, check here
i£vou want this processed through your account [~
DATE 9/26/03
JOB ADDRESS 846 W 12Th Street
Elizabeth Klos
OW'NER
CONTRACTOR
Palisades Sheet Metal ( t, 475 Racine Rd Menasha)
CH ~:CK [] ALL APPLICABLE
USE CATEGORY
~[ingle Family E]Duplex FIMulti-Family r'lRental
I-IConnnercial
[2Industrial
FUEL [~3as 13Electric nSolid SYSTEM [3New ~l~eplace
il nSolar FlOther
TYPE
/~orced Air [3Radiant VlSteam [2A/C V1Vent V1Electfic Elliot Water [3Suppl. nCon. Burner
IS CHIMNEY BEING LINED l~o nyes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
& MANUFACTURER
CI-HMNEY TYPE
HEAT LOSS
BTU RATE
F1Chimney A
[2]As Approved
F1As per Plan
n C1/ilf~i~y B:
[3Existing
[2Variable
tnNot Applicable
E1Other Value
rnOthe:
DESCRIPTION OF ALL WORK BEING DONE Furnace-Install
VALUE (Including labor and all materials including light fixtures) $ ,-~ ~/0~ OO
ELECTRICAL CONTRACTOR
[] 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