HomeMy WebLinkAbout0103837-Plumbing (relay)OSHKOSH
CITY OFOSHKOSH
PLUMBING PERMIT-APPLICATION AND RECORD
ON THE WATER
Job Address 665 GROVE ST
Contractor BERNDT EXCAVATING Category 401 - Residential-Exterior (laterals)
Bathtub 0 Shower 0 Ejector/Grind 0 DipWell 0 F Prep Sink
Whirlpool 0 Floor Drain 0 Water Soffner 0 Drink Ftn 0 Serv Sink
Lavatory 0 LndryTray 0 LocaIWaste 0 Wait. St. 0 Shamp Sink
Toilet 0 LndryStndp 0 Clothes Wshr 0 ice Chest 0 FIr/INst Sink __
Res. Sink 0 Disposal 0 Bidet 0 Exam Sink 0 Catch Basin
Bar Sink 0 Dishwasher 0 Beer Tap 0 SculrySink 0 Wash Ftn
Water Heater 0 Sump Pump 0 Dent. Oper. 0 Hand Sink 0 Urinal
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker
Owner SANDRA C ILK
No 103837
Create Date 09/02/2003
Plan
0 Gar Drain 0
0 Soda Disp 0
0 Coffee Maker 0
0 Iht Grease Trap 0
0 Ext Grease Trap 0
0 RPZ Valve 0
0 Eye Wash Statn 0
0
0
~FR/relay sewer & water
Use/Nature
of Work
Size Material Type #
Sanitary Sewer 6" Plastic Lateral
Storm Sewer
Conn. Type
Relay
0
0
0
0
0
0
0
0
0
Water Service 1" Copper Lateral 1 Relay
0
0
0
0
$50.00 [] PermitVoidedj
Valuation $1.500.00 Plan ApFc-~val $0.00~ Permit Fees
Date 09/02/2003
th 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 hold~(s~ and to s~ec~re ~[ny ne~sary approvals be~.su~.c~b activity.
Signature ...~_ [,~0...~.- ~--~ (~/(- ~ ~,/)-'~'(~J~/ Date
Agent/Owner
Address 2527 W WAUKAU AVE OSHKOSH WI 54904 - 0000 Telephone Number
235-3331
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.
City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh, WI 54903-I 130
Phone: (920) 236-5050
Fax: (920) 236-5084
O/HKO/H
Plumbing Permit Application
I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described, the work to conform to the
Wisconsin State Plumbing Code, in the performance of which all parties hereto agree to and are bound by said statutes.
· 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 [~
Job Address ~e~
Owner
C]Single Family
~,~-oO (Including labor and materials) /} Date
Value
Contractor
[--]Duplex ~'lMulti-Family ~lRental C]Commercial ['-]Industrial
Number of ]Fixtures:
Bathtub Lndry Standp Dent. Oper. Shamp Sink
Whirlpool Disposal Dip Well Flr/Wst Sink
Lavatory Dishwasher Drink Ftn Catch Basin
Toilet Sump Pump Wait. St. Wash Ftn
Res. Sink Ejector/Grind Ice Chest Urinal
Bar Sink Water Softn~r Exam Sink Gar Drain
Water Heater Local Waste Sculry Sink Soda Disp
E Gas G Elect E PwrVnt Clothes Wshr Hand Sink Coffee Maker
Shower Bidet F Prep Sink Ice Maker
Floor Drain Beer Tap Serv Sink Site Drain
Lndry Tray Classrm Sink lnt Grease Trap Roof Drain
Lab Sink Surgeons Sink Ext Grease Trap Standp Rec
Plaster Sink Breakrm Sink ILP.Z. Valve Eye Wash Stn
Sterilizer
Electric Contractor
Use / Nature of Work
Siz~
Sanitary Sewer ~
Storm Sewer
Water Serdce
tt
OR ]Electric Installation Verification form attached
(If Replacement)
T~e # Co~.T~e