HomeMy WebLinkAbout0105762-HVAC (boiler)OSHKOSH
ON THE WATER
.lob Address 55 MILL ST
Contractor VANS HEATING & A/C INC
Fuel ~J Gas ~
System ~J New
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Oil
Forced Air I ~J Radiant
Electric I ~J Hot Water
Owner MATHEW J KOZEL
Category 500- Residential-Heating & Ventilating
L~ Electric
Replace
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~ ChimneyA ~ 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
105762
12/16/2003
Other
Vent J
Use/Nature SFR/Replace boiler. *EIV form from Concept Services.
of Work
Fees: Valuation
Issued By:
$2,500.00 Plan Approval
$0.00 Permit Fee Paid
Permit Voided J
$42.50
Date 12/16/2003
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 525 BUTLER ST DEPERE WI 54115 -5426 Telephone Number
920-336-2816
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.
DEC -11 -2003 01:39P FROM: T0: 19207208644 P:1/2
City of Oshkosh
D
a CEIVE D
ivision of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130 DEC 1 5 2Q i
Phone(920)236 -5050
Fax (920) 236 -5084 , DEPARTMENT OF • -
HVAC PERMIT A WE I' OVELOPMENT
All information after bold categories must be pmvided.
incomplete applications will not be processed.
• Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, ' n 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
I you ,r • tor ie - a: in he -r, e: ccount tern a, r a e, are u ds chec here
if You want this processed throjgh your accoun_r
It ^
7 DATE ( ' ( T
JOB ADDRESS _ / ') l CA (. ' T
OWNER i t f"`1L►` �'
CONTRACTOR V(.l./
CHECK El ALL APPLICABLE
USE CATEGORY
ixtgle Family DDuplex DMulti- Family DRental DCommercial Dlndustri
FUEL Klipas DElectrie DSolid SYSTEM DNew fgrintolace
0011 DSolar DOther
TYPE y
DForced Air []Radiant OSteam C IA/C DVent DRlectric Slot Water DSuppl.DCon. Burner
iS CHIMNEY BEING LINED DNo DYes - LINERS ` IZE & MANUFACTURER J
j •
Note: All chimneys shall be sized per the BTU's being vented. {{
CHIMNEY TYPE DChimney A DChimney B ODirect Vent DOther
BEAT LOSS DAs Approved DExisting DNot Applicable �f i 1
DAs RATE Per Plan DVariabie DOther Value ;' -�
DESCRIPTION OF ALL WORK BEING DONE / 1')1(, (t f 1( 7h1
- i
V A L U E (Including labor and all materials including light f i x t u r e s ) $ • •- '
ELECTRICAL CONTRACTOR( U f 1.0 ,r ,{ Q& ❑ Electric Installation Verification form attached(tf Rc ccment)
c, . t lectricai installation ojnew 116w/replacement equips aN shall be Mine by licensed conuacron
•
3/02
DEC- ll~-~BB~ 01: ~SP FROM:
FROM : COnCePT S~JIC~
Electric Installation Verification
The nature or'the work consists oP. (Check One or D~scribe the Nnture of Work)
, ~, R~connection or n6w ch--~t fo~ replaccmeat Heating Plant anti/or A/C Condgnser.
Re, correction or n~e ~ircui! for r~place~-.~ lilcc~ric Wat~ Heater or powe~ Ve~xi
wat~ heater.
-----. Recon~ectlon of the ~ervice E~u~.~ce Cable, M~ter ]Box, alte~ions to taceptaclm
and lighting fixtures due to siding / soffit installation. Note; New Service
~.tnmce Cables will r,~..ui~ a ~,parate permit.
,.- Reformation or new circuit for the replacement of other l~rmanently wired
sppllnnces / fixtures.
N~w cir0uit foz h"te additio~ of A/C to an i~,#,l d~,~Zl~ ~ (house or th~
individual s~st~mos in a duplex o~ condo,~i-lum), in~udlng rcq~! sc~
olecaical outlet~
value of this work is S_ ,~00.~
,I hereby verify ~his work will be perYor~ed by an ~ploy~ Of this ~ompauy alld further verify
~he reconneotion / ins~llati~m will be don~ in complian~ with mauui'av'turcr and FA .egui~ code
(Signature of Company Officer) (Date) {
(Print N~'nc of Officer)