HomeMy WebLinkAbout0099721-Plumbing (dishwasher)City of Oshkosh
P 0 Box 1130
Oshkosh, WI ~4903-1130
Photo: (920) 236-$~0
Fax: (920) 236-5084
Plumbing Permlt tgi ,catton
I hereby apply for a permit to do and install the following plumbing on the premises hereinaRer descn~t, the work to conform to the
Wisconsin Slate Plumbing Code, in the performance of which all parties.hereto agree to and are bound by said statutes.
· Application(s) and fcc(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 11'28,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $I00.00 plus the
normal permit fec, which ever is greater.
OR
If you ar,e a contractor particit~ating,in the, Permit Fee Account System and have adequate funrl% check here
if you want this p,r,o, cessed through Four account
Job Address /~',~'--f,7'~=.-,.~.~-~, .t~.f Value 0.e~ding~bora~d.~-~)
Owner ~,' ~ ~-/-~ Contractor
'{~Single Family [--]Duplex F-]Multi-Family ~]Rental [-]Commercial
Date
~-[lndustHaJ
Number of Fixtures:
Bathtub I.ndry Standp Dent. Oper.
Whirlpool Disposal Dip Well
Lavatory Dishwasher --f---- Drink Ftn
Toilet Sump Pump Wait. St.
Res. Sink Ejector/Grind Ice Chest
Bar Sink Water Sofmer Exam Sink
Water Heater Local Waste Scutry Sink
~ c~ r~ ~ fi' ~,~vnt Cl°th= Wshr m.d S~k
Shower
Bi&-t F Prep Si~k
Floor Drain
.... Beer Tap Serv Sink
I~dry Tray ..... Ciassrm Sink iht Grease Trap
Lab Sink
-- Surgeons Sink Ext Grease Trap
Plaster Sink
Brenknn Sink
Sterilizer
Shamp Sink
Flr/Wst Sink
Catch Basin
Wash Fln
Urinal
Car Drain
Soda Dis0
Coffce Maker
Ice Maker
Sit~ Drain
Roof Drain
Standp 1~
Electric Contractor
Use / Nature of Work
~l~c Installation Verfficatidn form attached
(If Rephu:~x~nt)
Sanitary Sewer
Size
Material
Type # Conn. Type
Storm Sewer
Water Service
920-236-508,t
Electric Installation Verification
(print homeowner(s) name)
(addr~s where work is to tm performed)
accept the responsibility for performing the electrical work as stated below for the property listed
above.
The nature ofthe work cons~s~ of: (C~eck One or De~cribe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater.
Reconnoction ofth~ gervico Entrancc Cable, Met~ Box, altcxafions to rex~e~tacles
and lighting fixture~ due lo siding / soffit im~ailation. Note: New Servlee
Entrance Cables will require a ~rate permit.
(~thee~nnection or new circuit for other permanently wired applian~ / fixtures.
The vaI.e of tl~ work is ~~_.
I hereby verify tl~$ work will be performed by m= and further verify the reconnect/on /
installation will be done m compliance with manufacturer and Electric code requirements.
Hom=owngz(s) Signatur=
(Date)