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� CITY OF OSHKOSH 5�fju,No 113451
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECOR � ' � G
ON THE WATER '� J
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Job Address 422 CONGRESS AVE Owner THOMAS R WERBLOW Create Date 04/13/2005
Contractor ALBERT H KRUEGER Category 410-Residential-Interior Plan
Bathtub 0 Shower 1 Water Softner 0 Wait.St. 0 Shamp Sink 0 Coffee Maker 0
Whirlpool 0 Floor Drain 0 Local Waste 0 Ice Chest 0 Flr/Wst Sink 0 Int Grease Trap 0 �
Lavatory 0 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0 �
Toilet 2 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve p
Res.Sink
Bar Sink 0 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs 0 =
Water Heater 0 Classrm Sink p Sterilizer p Surgeons Sink p Ice Maker p i
p Deduct Meters
Site Drain 0 Breakrm Sink p Dip Well p F Prep Sink p Gar Drain p Wtr Usage Mtrs p �
Roof Drain 0 Ejector/Grind p Drink Ftn p Serv Sink p Soda Disp p i
' Misc. p
Fixtures
Use/Nature FR/ Converting a bedroom into a bathroom.
of Work '
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Size Material Type # Conn.Type q
Sanitary Sewer 0
0 ;
0 -
4
0
0
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Storm Sewer 0 ;
0
0
0
0
Water Service 0 `
0 c
0 �
� Parcel Id# _
� 1208800000 �
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Valuation $5,000.00 Plan Approval $0.00 Permit Fees $35.00 ❑ Permit Voided� �
Issued By Date 04/13/2005 �
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In the performance of his work,1 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 with' an sement,the City strongly urges the permit applicant to contact the �
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easement holder(s)an�tq��cure an ne sary approvals before starting such activity. ` �
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Signature ,�;�L , ��� Date X �'�f °���
AgenUOwner
Address W11706 SWAMP RD MARION WI 54950 -0000 Telephone Number 715-754-5574
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. �
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