HomeMy WebLinkAbout0104614-HVAC (furnace)OSHKOSH
ON THE WATER
Job Address 2t t3 HARRISON ST
Contractor BLACK-HAAK HEATING
Fue~ I,, I Gas I
System [] New
~J Fomed Air I
[, ,,I Electric I
Chimney Type Y~.~ ChimneyA
Heat Loss ~.~ As Approved
BTU Rate · As Per Plan
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Radiant
Hot Water
Owner JOHN H/MARY G HERBST
No 104614
Chimney B
Create Date 10/07/2003
Category 500 - Residential*Heating & Ventilating Plan
I I Elect~c [] So~ar
[] Replace ~ [] Other
L~ steam L~ NC J
I I suppl, I ~ con. Burner I
~.) DirectVent ~ Not Applicable
· Existing ~..~ Not Applicable I Value
{~ Variable (,.~ Other I Value
[] Solid
Vent
Use/Nature
of Work
E, FR/Replace furnace.
* EIV form from Krueger Electric.
Fees: Valuation $2,400.00 Plan Approval $0.00 Permit Fee Paid $41.00
Issued By: Date 10/07/2003
[] Permit Voided
In the performance of this work, I agree to perform all work pumuant 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
AgenrJOwner
Address PO BOX 3070 APPLETON WI 54914 -3070 Telephone Number (920) 757-9990
To schedule inspections please call the Inspection Request line at 236-5'128 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.
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh. WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
RECEIVED
OC-f O-
HVAC PERMIT
All information after bold~[~'~t [~ ENT
Incomplete applications will not be processed.
O/HKO/H
· 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 gl00.00 plus the
normal permit fee, which ever is greater.
OR
/£vou are a contractor participatin~ in the Permit fee Account System and have adequate funds, check here
if you want thisprocessedthroughvouraccount [-~ ~///~,~/~L,,.~
DATE .
JOB ADDRESS 9//'~ p~O;O S -T~
CHECK ~ ALL APPLICABLE
USE CATEGORY
~Single Family I"IDuplex EIMulti-Family FIRental
FUEl. FlGas ElElectric ElSolid SYSTEM
E]Oil ElSolar
E1Commercial Ellndustrial
reNew IDReplaee
E]Other
TYPE
~.Forced Air [2Radiant FlSteam EIA/C ~Vent ElElectric
IS C~Y BEING LINED ~lNo [2~es - LINER SIZE
Note: All chimneys shall be sized perlite BTU s being vented.
CI~MLNEY TYPE
HF~AT LOSS
BTU RATE
F1Chinmey A
F'lAs Approved
IJAs Per Plan
[2 Chirmney B
[~Existing
[2Variable
t2Hot Water FISuppl. I-ICon. Burner
& MANUFACTURER
DESCRIPTION OF ALL WORK BEING DONE
FlDirect Vent
E]Not Applicable
[2Other Value
VALUE (Including labor and all materials including light fixtures) $ c-~a/tgt9
Q For applicable projects, an Elec~c ~st~lation V~fication fo~ si~ed by ~e Elee~cal Con.actor. must be
a~ched. If not a~ched or not applicable, a separate Elec~cal Prat is requked~
9/02
Electric Installation Verification
(I) (w¢} ....
(Address) (City) (StaT~ (Zip Code)
have bc~n contracted to P~onn electric im~ulMt~on work for ~
./
at thc tbtlowing address: ~ [[~ ~f~'~o~
(Ad~ Wh~* work ~ b* p~om~)
The nature of the work consists of: (Check One or Dce, cribe the Natm'o of Work)
Q Reconnection or n~.w circuit for mplae~t Hea6ag plmat md/or PJC Cond~ms~r.
..... Re¢omaection or new uirmiit for replacement ]~l~ctd¢ Water H~tt~r.
.... Reco,mection of'the Service Eat'anco Cable, Meter Box, alterations to receptacles and
lighting fixtmrcs duc to siding / soffit installation, Note: New Service Entrane,~
C'at~[m will require a s~paratc l~a'mit.
...... Reconnection or n~w cimuit tbr other pcrman~.'ntlywlred ~plianc~ / fixtures.
OtJ~
The value oft.his work iS $ /]"~'~
hereby verify this work will b,' performed b'y an ~mployee of this company and iurther verify the
r~connemion / hmallaJion w~ll bc done in complhmc~ with manuthctun= and El,ctric co{lo
requirerments.
(Print Ne-mc of Offie~
(Date)