HomeMy WebLinkAbout0104730-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
.lob Address 1247 JACKSON ST
Contractor TENTH STREET STATION INC
Fuel
System
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Gas J ~J Oil
New J
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner ALLAN T EKVALL
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type IO Chimney A ~) Chimney B O Direct Vent ~ Not Applicable I
Heat Loss ]~ As Approved O Existing ~ Not Applicable ] Value
BTU Rate ]~ As Per Plan ~) Variable ~ Other ] Value
No
Create Date
Plan
L~ Solid
104730
10/10/2003
Other J
Vent J
75m btu & 2.5T a/c
Use/Nature SFR/Replace furnace and add new a/c.
of Work
Fees: Valuation
Issued By:
$5,100.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$81.50
Date 10/10/2003
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 924 OHIO STREET OSHKOSH WI 54902 -0 Telephone Number
236-8770
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.
FROM :TENTH STREET STATION, INC. FAX NO. :920-236-0150 Oct. 10 28~3 08:24AM P1
Civ/of Oshkosh
D/v/s/on of Io~pection Services
P.O. Box 1130
Osb. ko~h, WI 54903-I 130
Phone ('920) 236-5050
Fax (920) 2364084
HVAC PERMIT APPLICATION
All reformation after bold categories mu~ be provided.
Incomplete applications will 9or be processed.
ON TH~ WATER
· ApplicatiOn(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection S~rvic~, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees be/rig doubled or $100.00 plus the
normal pertmt fee, wh/¢h ever is greater.
OR
~f Fou are a contractor t~articipatin~ in the Permit fee Account SFstem and have ~daquate.£unds. check here
ii-you want this i~roc~rssed throi~h your account ~e
comat croa s-r m
CHECK [~ ALL APPLICABLE
USE CATEGORY
~l~ingl¢ Family r'lDuplex CIMulfi-Family [3Rental
ElCommercial
DIndus~al
FUEL '~a$ EIEI¢ctdc EISolid SYSTEM
~Oil , ClSolar
~Forced Air r'lRadiant r'lsteam' [3A/C EVent [3Electric
IS CHIM1VEY BEING LINED [~No I~Yes - LL~ER SIZE
Not~: All chit~tleys shall be sized per thc BTU's be/rig vented.
·]New ~tc_ [ZSReplace
~O~her
E]Hot Water E]Suppl. r'ICon. Burner
& MA-,N-LIFACTUI~R' l"~t.~e'~l ~
CtHMNEY TYI'E ClChinmey A [3Chinmey B
H~AT LOSS ~As Approved ,[~Exist/ng
BTU RATE l~A$ Per Plan ~Vanable
BESC,IOPTION O~/,ALL WORK BEING DONE
13~Direct Vent
i'~Not Applicable
clObber Value
yALU]/: (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR
~E For applicable projects, an Electric Installation Verification form, signed by the t/leetrical Contractor, must be
at~:ached. If not attached or no~ applicable, a separate £1ectr/ea] Permit is required.
FROM :TENTH STREET STATION, INC.
FAX NO. :g20-~-0150 Oct. 10 2005 08:L~M P~
Electric Installation Verification
O~lectrical Contractor Nmne) --
. ~Addrcs~) (City) (State)
' ' ' (ZipCod~)
' : ' ~e ofp~y ~tracted to)
(A~ess wh~m work will be peffo~ed)
:'.. · The nh~ure of~e ~ork consis~ of: '(Check One'or Deschbe ~e Na~e of Work)
' · .... '...: ~ R~0nn~on or n~ ekcuit for r~l~emm/Hca~ Pl~t . .
· ." ' ~ . Re~o~tmn or new circuit for r~lacem~. =,~-~ - .... .~or ~C Condenser'
.. ....:w~ heaI~.-r ....~*cmc w~er rleater or power V~ited
' ' R~om~tion of the Semite En~ce Cable, Mef~ Box, ~t~fions to raccptacl~
' ~d lighfi~ ~r~ due to sidi~ / soffit ins~afion. Note: New S~icc
' ' Bn~ce.Cabl~.~ll r~uire a s~ate pe~t.
. · ~.'. -. .R~on or n~ circuit for the replacmncnf of o~ petulantly
.' . ~. ~ . appU~c~ / ~tures.
. . _ New ckeuit for tho a~fion of ~C to m indi~,id~l dwelling u~ ~ouse or
~vidual sy~ in a dupl~ or ~ndomi~um), ~clud~g required
elecMcal ou~,~.
' ' The v~ue offs work is $~,*O -
' }" ..: · ' .. . ' . --' : . , ." ." , '"., '."~':~'"... ...'.".', .
.'
' · P~Y Officer) ¢~int N~e of Officer) ' ' ~' -
' · (Date) '