HomeMy WebLinkAbout0104849-HVAC (furnace)OSHKOSH
ON THE WATER
.lob Address 960 BAVARIAN CT
Contractor DRUCK'S PLBG & HTG & CLG
Fuel [~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Owner MR/MRS HENRY A SAMPSON
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
Forced Air I ~J Radiant
Electric I ~J Hot Water
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type IO Chimney A ~) Chimney B ~ Direct Vent O Not Applicable I
Heat Loss I~ As Approved ~ Existing O Not Applicable I Value
BTU Rate I~ As Per Plan ~ Variable ~) Other I Value
No
Create Date
Plan
L~ Solid
104849
10/20/2003
Other
Vent J
Use/Nature SFR/Replace furnace. *EIV form from Heritage Electric.
of Work
Fees: Valuation
Issued By:
$3,200.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided J
$53.00
Date 10/20/2003
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 504 3RD ST P O BOX 355 MENASHA WI 54952 - 0 Telephone Number
(920) 426-2654
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.
Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Os~Lkosh, WI 54903-1130
Fax # (920) 236-5084
Phone (920) 236-5048
HVAC PERMIT APPLICATION OCT 1
JOB ADDRESS
CONTRACTOR
CIRCLE ~L APPLI~LE
F~L ~ OIL
SYST~ NEW
~PE ~ORCED
ELECTRIC
IS ~I~Y BEING LI~D
All fields/information after bold categories must be provi~t~H
~n~o~piete applications wiii not he processed. U'~.T'ART~FNT OF
CO~UNITY DEVE~n~,~
DATE /O - /,~ ~
DUPLEX MULTI -FAMILY
ELECTRIC SOLAR
P-AD IAi~T STEAM
HOT WATER SUPPL.
LINER SIZE ~ :'/'~5' '
Note: Ul chimneys shall be sized per the BTU's being vented.
COMMERCIAL
SOLID
CHI~INEYTYpE
HEAT LOSS
BTU RATE
NATUKE OF WORK:
CHIMNEY A
AS APPROVED
AS PER PLAN
CHIMNEY B
EXISTING
A/C VENT
CON. BURNER
MANUFACTURER
DIRECT VENT
OTHER VALUE
INDUSTRIAL
OTHER
.VALUE (Including labor and materials) $
ELECTRICAL COIT~RACTOR /-/'67Z.~W~a'
Electrical installation of new/replacement equipment shall be done by licensed
contractors.
Valuation Fees
$0 to $1,000.00 .................................................................................................. ~ ...................... $20.00
$1,000.01 to $10,000.00 ................................................................................................ $20.00 for first
$1,000.00 plus $1.50 per $!00.00 valuation or part thereof
$10,0~0.01 to $25,000.00 .............................................................................................. $155.00 for first
.... :~:~ .~ , $10,000.00~ plus $1.00 per $100.00 valuation or part thereof
Over $25,000.00 ............................................................................................................... $305 00 plus $0.50
per $100.00 valuation or part thereof
· Submit payment with application. Failure to pay within 30 days will result in
fees being, doubled or $100.00 plus the normal permit fee, which ever is
greater.
1~/02/2003 14:10
~207343838
HERITAGE
PAC~E ._.0_~i .........
Electric Installation Verification
Cole)
., ~ R~on ~ n~ ci~t for ~la~ Hca~ ~t ~d~ ~C Co~.
_ R~o~ecdOn or new ~it ~or r~l~c~ ~[~c Wat~
~c~on of ~ ~e ~c C~lc, ~ Box. ~a~s ~o
~i~ ~ ~ ~o ~g / ~ ~1~. N~: New S~e
or n~ ~mt for o~er p~,.~y ~ ~h~ / ~.
The v,~u¢ of ~his work i~ $
hereby ve. nfy fids work will be p~T-oi~cd by ~ employee of fids c~ripany and f~lter ve, ti~ the
reao.tmec6on / i~llatio~ w~B be done in eempliance with manu~aclurtr a~id t;l~,Aric code
r~qutr~a~r~.
(Pr/m Name of