HomeMy WebLinkAbout0105360-HVAC (furnace)OSHKOSH
ON THE WATER
.lob Address 108 E PARKWAYAVE
Contractor A-1 HEATING & A/C INC
Fuel
System
Gas J ~J Oil
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Owner RANDY PASSEHL
Category 500- Residential-Heating & Ventilating
L~ Electric
New ] ~] Replace ]
Forced Air ] ~ Radiant
Electric I ~J Hot Water
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~) Chimney A ~) Chimney B ~ Direct Vent O Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value
BTU Rate I~] As Per Plan ~] Variable ~ Other I Value
No
Create Date
Plan
~ Solid
105360
11/17/2003
Other ]
Vent
Use/Nature SFR/Replace furnace. *EIV form from Bell Electric.
of Work
Fees: Valuation
Issued By:
$2,000.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$35.00
Date 11/17/2003
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 W8078 HILLCREST COURT HORTONVILLE WI 54944 -0 Telephone Number
(920) 779-8838
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.
(:ity cf ()shkostt
tiivision of Inspection Services
1'.O. 13ox 1130
(.)shkosh, WI 549U3-t 13U
1'lu>ne (92U) 236-5050
i~ax (92U) 23G-50$4
HVAC PERMIT APPLt
All information after bold categoxies rr
incomplete applications will not b~
• Application{s}and fce{s) can be brought to City Hall, Room 2(}5 or mailed to Inspection Services, I'U Box 1 128,
t)shkosh WI 54903-1128. Commencing work without permit{s) will result in fees being doubled or $100.00 plus the
normal permit fce, which ever is greater.
UR
/Burr rrre a c'vrttractnr ~~ur_trci~atirrg i,rr the Perrnlt i,u Account SYStem nr~c/ huvr nde~trrter funds, cheek Irerc
1 }~nrr tit~unt this prvccrsser! thrr~rrg{r ,ynrrr rtccurrrrt
DATE_.._._...,~i~~~
.IOB ADDRESS ,Q ~ ~ ~pr'1C ti!!'~~!____..._...~3 ~',`f~
OWNER~dth~._~A,f.,~_e_~ ~,_--
CC)NTIZACTOR_.~~/~~~f~ o` /~t~r Cua ~l dyon i Ncl Sao •- ~~y - F~'3 ~
CHECK ®ALL AI'PI,ICABLE
USF CATF.,GORY
~n~le Family DDuplex ^Multi-Family
Fl)EL ias ^llectric DSolid
D(}il DSolar
^Rental ^Commercial
SYSTEM ^New
^Other
^Inclustrial
J~place
TYPE
~t'iirced Air ^Radiant ^Steam ^A/C ^Vent ^Elecri-ic DHot Water ^Suppl.^C'on. Burner
IS C'HIMNF..Y BEING I..INED f~'1~Io ^Yes -LINER SILL___ ~k MANUFACTURF;R
Note: All chimneys shall be siicd per the 13TI_)'s beinb vented. '
CHIMNEY 'T'YPE ^Chimney A ^Chimney B DDirect Vent her ~~'~
NEAT LOSS ^As Approved Q~xistinb ^Not Applicable
BTU RATF, ^As Per Plan ^Variable aHther Value rid' oft' ~irLC. _
DESCItIPTIUN OF ALL WURK BEING DUNE___~-G~ydcQ ~Lye~P,Q~,ptip~y~"
/ .r ..__~.......
VAL[?E (1neluciing tabor and all materials inctnding light fixtures) $ .__._~dD (,'-. ~ ~
ELECTRICAL C:ONTRAC'TUR_, ',PLL_~[~edi^i~_ DR i I Electric tnstallatlon Verification form attachedOF Itcptaccmcnt)
I:/rrUrcnl insratturinn rf nrm/rc~itacen+rrN rquiprnrnt skull tx'' doer Lr tirrasrrt ronrrnclors.
~`- /gym 9 ~ ~~wacL ~' ~ ~ ~ v
P
:i/02
(We) e z (
Electric Installation Verification
(Electrical Contractor Name)
(Address) (City)
have been contracted to perform electric installation work for
at the following address:
,,<,/
(State) (Zip Code)
(Name of party con~tracted to)
(Address where wgrk will be perforraed) /,5/--/d .KS
The nature of the work consists off (Check One or Describe the Nature of Work)
_~ Reeonnection or new circuit fbr replacement Heating Plant and/or A/C Condenser.
~ Reconnection or new circuit 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.
__ Reconnection 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 dnplex or condominium), including required service
electrical outlets.
Other
The value ofthis work is $
1 hereby verify this work will be performed b ' '
y an employee oftNs company and further verify
the reconnection / installation will be done in compliance with manufacturer and Electric code
rcquiremell
(Signature oFCotnpany Officer)
(Print Name of Officer) (Date)