HomeMy WebLinkAboutHVACPermit
Heating &A/C Permit Application
P O Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
www.oshkoshwi.gov
Project
Address
________________________________________________________________________________________
Applicant □ Owner □ Contractor □ Tenant □ Other (describe)__________________________________
Owner /
Tenant
Name__________________________________________________ Phone___________________________
Address_____________________________________________ Email______________________________
Contractor Company Name__________________________________________ Phone____________________________
Contact______________________________________________ Email_______________________________
Address__________________________________________________________________________________
State Credential #’s____________________________________ HVAC Contractor Lic #
Type of
Work
□ Heating □ Air Conditioning □ Both
Use □ Residential □ Commercial
Chimney
Type
□ B-Vent □ Direct Vent □ Existing Masonry □ Lined Masonry □ Single Wall
Appliance
Type
□ Air Conditioner □ Air Handler □ Elec Unit Heater □ Gas Boiler □ Gas Furnace
□ Gas Unit Heater □ Oil Boiler □ Oil Furnace □ Roof Top Unit □ Other_________________
Project
Description
**Include
the # of
appliances
and BTU’s
for each ap-
pliance**
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Value of Job $ ____________________ (Value for materials & labor is req. to ensure consistency in accessing permit fees for all applicants.)
Payment by: □ Check #______________ □ Cash □ Credit/Debit Card (office or online only)
I certify the above information is complete and accurate. Any deviations from the above submitted information may require ad ditional permits
to be obtained. I acknowledge and agree to these terms.
Name: _____________________________________________ (Please print) Date: _______________________
Signature: ___________________________________________