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CITY OF OSHKOSH
No
OSHKOSHHVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
CLASSIC HOMES
Job AddressOwner
2440 SHORE PRESERVE DR
Create Date10/21/2003
ContractorBLACK-HAAK HEATINGCategory502 - Residential-BothPlan
OilElectric
üü GasSolarSolid
Fuel
üü NewReplaceOther
System
üü Forced AirRadiantSteam üü A/CVent
ElectricHot WaterSuppl.Con. Burner
Chimney TypeChimney AChimney BDirect VentNot Applicable
Heat LossAs ApprovedExistingNot ApplicableValue0
As Per PlanVariableOther
BTU RateValue
Use/Nature
NSFR/ Install heating system in new home. Furance is 75m btu and central air is 36m btu.
of Work
Plan Approval$0.00
Fees: Valuation$5,000.00Permit Fee Paid$80.00
Issued By:Date12/05/2003
Permit Voided
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.
SignatureDate
Agent/Owner
AddressPO BOX 3070APPLETONTelephone Number920-757-9990
WI54914-70
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.
4 ®d
•
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050 EVED
Fax (920) 236 -5084 OfHKOfH
ON THE WATER
HVAC PERMIT APG6A bN
All information after bold categ must be rovided.
Incomplete applications wl11bNTeLIF
COMMUNITY DEVELOPMENT
• 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
if you want this processed through your account (i
DATE ! /r' 1
JOB ADDRESS 9 . i t 9O ( S �O� PrcServ�. .
OWNER j lC_ gOhi
CONTRACTOR (QCK— Aoct P }1fc it
CHECK ALL APPLICABLE
USE CATEGORY
' Single Family ❑Duplex ❑Multi- Family ❑Rental ❑Commercial ❑Industrial
FUEL leas ❑Electric ❑Solid SYSTEM (atNew ❑Replace
❑Oil ❑Solar ❑Other
TYPE
I&Forced Air ❑Radiant ❑Steam ❑A/C ❑Vent ❑Electric ❑Hot Water ❑Suppl. ❑Con. Burner
IS CH MNEY BEING LINED ❑No ❑Yes - LINER SIZE VIA & MANUFACTURER
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE ❑Chimney A ❑Chimney B gDirect Vent ❑Other
HEAT LOSS 18As Approved ❑Existing ❑Not Applicable
BTU RATE iitAs Per Plan ❑Variable ❑Other Value
DESCRIPTION OF ALL WORK BEING DONE 46401( o f %n S S /em ;h net.) h om
4 fActte ►S 4 98% e1 ;c.eki 7S,000 127 ro A1Sa ee 34
2 7Tu e.exxV c6rs C'Ov ;o4 e r
VALUE (Including labor and all materials including light fixtures) $ .S1019 -..cOGU
ELECTRICAL CONTRACTOR " P t r GC LeLr; C,
0 For 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