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� CITY OF OSHKOSH No 99160 SC�ti�
�v�s�o
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD a
ON THE WATER '9TE '
Job Address 424 W NEVADA AVE Owner PETER H ZABORSKI Create Date 12/20/2002
Contractor FARMERS SUPPLY CO Category 410-Residential-Interior Plan
Bathtub 0 Shower 0 EjectoNGrind 0 Dip Well 0 F Prep Sink 0 Gar Drain p t
Whirlpool 0 Floor Drain 0 Water Softner 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
Lavatory 1 Lndry Tray 0 Local Waste 0 Wait.St. 0 Shamp Sink 0 Coffee Maker 0
Toilet 0 Lndry Stndp 0 Clothes Wshr 0 Ice Chest 0 FINWst Sink 0 Int Grease Trap 0
Res.Sink 0 Disposal 0 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
Bar Sink 0 Dishwasher 0 Beer Tap 0 Sculry Sink 0 Wash Ftn 0
Water Heater 0 Sump Pump 0 Dent.Oper. 0 Hand Sink 0 Urinal 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
Use/Nature FR/Install lavatory.
of Work
�
Size Material Type # Conn.Type
Sanitary Sewer �
0
0
0
0
Storm Sewer �
0
�
0
0
0
Water Service 0
0
0
0
0
Valuation $300.00 Plan Approval $0.00 Permit Fees $20.00
Issued By �,� Date 12/20/2002
� PeRnit Voided�
In the perfo nce of this work,I agree to perform all work pursuant to rules governing the described construction.
Signature _ Date �� ��o-v 2
AgenUOwner
Address 34 W 7TH AVE OSHKOSH WI 54902 -0000 Telephone Number 235-6970
. . - .
: City of Oshkosh � `-'�'`'�''��i���
�,�
Inspection Services Division � �'�A�� �o ,
P O Box 1130 �;
Oshkosh,WI 54903-1130 ` :��
Phone:(920)236-5050
Fax:(920)236-5084 O HKO1H
ON THE WATER
� � Plumbing Permit Appiication
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 perforn�ance 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
1f vou are a contractor narticinatinQ in the Permit Fee Account Svstem and have adeguate funds check here
f vou wcrnt thts Drocessed through vour account n
Job Address �� l 7� ��/p����� Va]U@ (Including labor and materials)__ �Gd G`
Date ;.� -�a -� z
Owner S���= 2� �o,-s ,�," Contractor y u,-,,,�,5 S� , i,L �
`�Single Family ❑Duplex ❑Multi-Family ❑Rental
❑Commercial ❑Industrial
Number of Fixtures:
Bathtub Lndry Standp Dent.
�• Shamp Sink
Whirlpoo] Disposal Dip Well Flr/Wst Sink
Iavatory e� Dishwasher Drink Fm Catch Basin
Toilet Sump Pump Wait.St.
Wash Fm
Res.Sink Ejector/Grind Ice Chest Urinal
Bar Sink Water Sofiner
Exam Sink Gar Drain
Water Heater Local Waste Sculry Sink Soda Di
-Gas=Elect C PwrVnt �
Clothes Wshr Hand Sink Coffee Maker
Shower Bidet
F Prep Sink Ice Maker
Floor Drain Beer Ta
p Serv Sink Site Drain
Lndry Tray Classrm Sink
Int Grease Trap Roof Drain
Lab Sink
Surgeons Sink Ext Grease Trap Stand Rec
Plaster Sink P
Breakrm Sink
Sterilizer
Electric Contractor OR DElectric Installation Verification form attached
(If Replacement)
Use/Nature of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer �
Water Service
s/oz