HomeMy WebLinkAbout0105440-HVAC (furnace & a/c)OSHKOSH
ON THE WATER
.lob Address 925 HERITAGE TRL
Contractor DRUCK'S PLBG & HTG & CLG
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 DAVID M LERLIE
Category 502- Residential-Both
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA O Chimney B
Heat Loss I~ As Approved ~ Existing
BTU Rate I~ As Per Plan ~ Variable
Direct Vent
Not Applicable
Not Applicable
Other
Value
Value
No
Create Date
Plan
L~ Solid
105440
11/21/2003
Other
Vent J
Use/Nature SFR/Replace furnace & A/C. *EIV form from Heritage Electric.
of Work
Fees: Valuation
Issued By:
$5,000.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$80.00
Date 11/21/2003
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 P O BOX 355 MENASHA WI 54952 -355 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
Osb~kosh, WI 54903-1130
Fax # (920) 236-5084
Phone (920) 236-5048
HVAC PERMIT APPLICATION
All fields/information after bold categories must be provided.
Incomplete applications will not be processed.
JOB ~DRESS
CIRCLE ~L ~PLI~LE
F~L ~ OIL
SYST~ NEW
ELECTRIC
DUPLEX MULTI-FAMILY
ELECTRIC SOLAR
~ OTHER
RADIANT STEAM
HOT WATER SUPPL.
DATE
/ ~'-
RECEIVED
NOV 19 2O03
D~P~RI%~ENI' 0
SOLID
VENT
CON. BURNER
IS CHIHNEY BEING LINED LINER SIZE
Note: All chimneys shall be sized per the BTU's being vented.
CHIMI~EY TYPE CHIMNEY A ~Y~
DIRECT
VENT
HEATLOSS
BTU RATE AS PER PLAN VARIABLE OTHERVALUE
MANUFACTURER
OTHER
NATugE OF WORK:~ ~u~c~ /~UZ) ,~
.VALUE (Including labor and materials) $
ELECTRICAL CONTRACTO~/6r~ZY ~6
Electrical installation of new/replacement equipment shall be done by licensed
contractors.
Valuation Fees
$0 to $1,000.00 ................................................................................................... ; ................... $20.00
$1,000.0! tO $10,000.00 ...........................................................................................$20.00 for first
$1,000.00 plus $1.50 per $100.00 valuation or part thereof
$10,0Q0.01 to $25,000.00 ............................................................................................... $155.00 for first
< ~!~ !91 $10,000.00 plus $t.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.
Electric Installation Verification
~ve bee~ conw~ to perform el~tri~ inslaila~ion work for ~5 ...... J~* ,- ~4 ,-'~
{Nimle of party con~acxecl to)
(Address wh~re wo~ will b~ perfoemed)
~ oa~ o£rhe work consists of: (Clle~k One oF Describ~ t~ N,~u~ ot'Work)
_v/Re~onne~lion or new circ~il for ~hc~t H~g ~t ~or ~ C~d~.
~ecli~ or n~ ci~t for ~]~t
..... Re~tion of~e Sempe ~n~ C~Ie, M~r
~ li~ng ~ duc ~ siting /
Cab~s ~11 ~qui~ a sep~ae
~ R~U or new civet for o~
Theva~u~ort, his work is !} .._3_~Oc'~, ~ O.
[ l~eroby v~ri~y this work will b~ performed by an cmployce t~f this ¢.omp~ly and f~. ~r ve~y the
rectmnection / installalioZ will be done in compliance wilh ~anu~sclur~ mad El~ctnc code
teultuh'¢ment~. ,
../O~.:=X,,~ /'0-l,,--.-. /0
: a'nm Name of qintar)