HomeMy WebLinkAbout0105033-HVAC (2 furnaces)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 bc processed.
OSHKOSH
JOB ADDRESS //~c:~
CONTRACTOR
· 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
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
i£¥ou want this processed through your account [~
DATE
CHECK [] ALL APPLICABLE
USE CATEGORY
l~Singl¢ Family DDuplcx ~Multi-Family
FIRental FICommercial Fllndustrial
FUEL [g/Gas FIElectric FlSolid SYSTEM F1New ~'Replace
FlOil [Solar FlOther
ced Air []Radiant FISteam []A/C F1Vent F1Eleclric
IS CHIMNEY BEING LINED ~fNo [Yes - LINER SIZE
Note: All chimneys shall be sized per the BTU's being yented.
[]Hot Water []Suppl.
& MANUFACTUKER
CltlMNEY TYPE []Chinmey A []Chimney B []Direct Vent
ItEAT LOSS IZIAs Approved FIExisting I~Not Applicable
BTU RATE []As Per Plan [Variable []Other Value
DESCRIPTION OF ALL WORK BEING DONE .~.~? f~'~":~/'~7 ~
mother
[Con. Burner
VALUE (Including labor and all materials including light fixtures) $ q~-g~5~ ~ ~
ELECTRICAL CONTRACTOR .~d-/~-~-- ~~--~
~fFor 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
City of Oshkosh
Division of Inspection Services
215 Church Avenue
POBox 1130
Oshkosh WI 54903-1130
Office 920~236-5050
Fax 920-236-5084
Electric Installation Verification
I (We)
(Electrical Contractor Name)
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for ~..//~ ~c07x7 /4{44q'7/"-e, ~/~'~'h
(Name of party contracted {o)
at the following address: //~ /~J ?~//?,x/~
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new cimuit for replacement Electric Water Heater or power vented
water heater.
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.
Recormection 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
The value of this work is $/.~" ~
I hereby verify this work will be performed by an employee of this company and further verify
the recgr~ectmn / installation will be done in compliance with manufacturer and Electric Code
requ)~n~nts.
/ ~r)"~ /(1Jridt Name of Officer~ (/Sate)
5/02