HomeMy WebLinkAbout0102722-HVAC (furnace & a/c)(~ CITY OF OSHKOSH No 102722
OSHKOSH HVAC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1235 FAIRVIEW ST Owner JEFFERY L GRUSS
Contractor AMERICAN HEATING & A C CO Category 502- Residential-Both
Fuel ~J Gas J ~J Oil b~ Electric ~J Solar I L~ Solid
System ~J New ~ ~J Replace ~ ~J Other
~J Forced Air I ~J Radiant L~ Steam ~J A/C 1
~J Electric I ~J Hot Water L~ suppl. ~J Con. Burner 1
Chimney Type I~ Chimney A ~ Chimney B O Direct Vent ~ Not Applicable I
Heat Loss I~ As Approved O Existing ~ Not Applicable I Value 0
BTU Rate I~ As Per Plan ~ Variable ~ Other I Value 75m btu & 24m a/c
Create Date 07/09/2003
Plan
Vent J
Use/Nature SFR/REplace furnace and add 2 ton central A/C. *EIV form from Seckar Electric.
of Work
Fees: Valuation $4,300.00 Plan Approval $0.00 Permit Fee Paid $69.50
Issued By: Date 07/09/2003
Permit Voided J
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 1129 MICHIGAN AVE OSHKOSH WI 54902 -6437 Telephone Number (920) 235-8090
~City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
JuL o 'F- K H
All information after bold categories must be p~*o~
Incomplete applications wilt not be processed. ~t~ ~
Application(s) and fee(s) can be brought to Ci~ Hall, Room 205 or mailed to Inspection Se~ices, PO Box 1128,
Oshkosh WI. 54903-1128. Commencing work without pemit(s) wilt result in fees being doubled or $100.00 plus the
nomal Pemit fee, which ever is ~eater.
OR
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
if you want this processed throa~h your account
DATE
JO A, SS
CHECK [] ALL APPLICABLE
USE CATEGORY
~ingle Family [3Duplex
F1Multi-Family [3Rental
[3Commercial
[3Industrial
FUEL ~-Gas [-]Electric [2Solid SYSTEM [3New ~eptace
I-qOil E]Solar E]Other
~PE
orced Air ClRadiant ElSteam~2~/C C1Vent [3Electric E]Hot Water ZlSuppl.[3Con. Burner
IS CHIMNEY BEING LINED UNo ~Yes - LINER SIZE ,.~ ~.__ &
Note: All chimneys shall be sized per the BTU's being vented.
CHIMNEY TYPE
HEAT LOSS
BTU RATE
FIChimney A
ElAs Approved
I-lAs Per Plan
[3Chimney B
~Existing
E]Variable
I~Efirect'Vent E]Other
ElNot Applicable
l~Other Value 70~.~0~ ~r,/ - 2~f~agz' /J~/C_.
DESCRIPTION OF ALL WORK BEING DONE ~:>//~ C,~- .
ce,.,Y.¢_,, L
VALU'E (Including labor and all materials including light fixtures) $
ELECTRICAL CONTRACTOR
OR ~f---F4ectric Installation Verification form attached(l£Replacemem)
Electrical installation of new/replacement equipment Shall be done by licensed contractors.
~/o~
Electric Installation Verification
(EI~c~ ~n~ctor N~e)
(Ad~e~) (City) (State) (Zip Code)
have b~n con~act~ to p~o~ ~lect~c inUallafion work for ~
~m~ of pray Con~act~ to)
at me following ad~=s: /Z2~
(Ad~e~ where work will ~
The nature of the work consists off (Check One or Describe the Nature of Work)
~ Reconnection or new circuit for replacement Heating Plant and/or ,adc Condenser.
~ Reconnect'ion or new circuit for replacement Electric Water Heater or power vented
water heater.
~ Reconneetion of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding / soffit installation. Note: New Sen, ice
Enl~nce Cables will require a separate permit.
Recormection or new circuit for the replacement of othe~ permanently wired
appliances / fixtures.
... New cimuit for the addition of MC to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer end Electric code
requirements.
(Print Name of Officer)
(Dato)
5~2