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"8 CITY OF OSHKOSH No 116139
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1016 MACARTHUR RD Owner JEFFREY JICARLA HAEN Create Date 0910612005
Contractor SAMMONS PLUMBING Category 411 - Residential-Water Heaters Plan
Bathtub 0 Shower 0 Water Softner 0 Wail.SI. 0 Shamp Sink 0 Coffee Maker 0
Whirlpool 0 Floor Drain 0 Local Waste 0 Ice Chest 0 FlrlWst 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 0 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0
------, Dishwasher Hand Sink 0 Urinal 0 Eye Wash Statn 1;1
Res. Sink 0 0 Beer Tap 0 0
Bar Sink 0 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs 0 I.j
Water Heater 1 Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters 0
Site Drain 0 Breakrm Sink 0 Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs 0
Roof Drain 0 Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
Misc. 0
Fixtures
Use/Nature
of Work
Valuation
Issued By
Install electric water heater* EIV from Slim's Electric lne
Size Material Type # Conn. Type
Sanitary Sewer 0
0
0
0
0
Storm Sewer 0
0
0
0
0
Water Service 0
0
0
0 Parcelld #
0 0000000000
II
Ii
$700.00 Plan Approval
$0.00 Permit Fees
$20.00 D Permit Voided I
Date 0910612005
In 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, jf you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the
easement holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Agent/OWner
OSHKOSH
Address 522 W. MURDOCK AVE
WI 54901 - 2298 Telephone Number 231-9880
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.
... t:
FROM :SAMMONS PLUMBING
FAX NO. :9202318485
Sep. 02 2005 02:30PM P5
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PiviQon ot.1JlllplCdaa t.lMcn
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1'0110I.100
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Electric InstallatioD Verification
I (We)
SLIM'S ELECTRIC INC.
(Electrical Caattactor Name)
2608 Oakwood Circle Oshkosh WI 54904
(Address) (City) (State) (Zip Ccxle)
have be=! contracted-to perfonn electric iIIstallation work ror Sammon's plum '. .
(Name ofpal'ly ~cd to)
at the following~:
1016 Macarthur
(Address whem worlt will be performed)
The nature ofw wozk roDSistsof: (Check One or Dellcribe the Nature ofWorlt)
'Recomlection or n_ cirellit for replacemeat Hca1:inB Plant 8!IdIor Ale Col:>d...........
-X- Reconnection or new circllit for replacClDlCD1 Electric Watcf Healer or pawcr vented
water bealer.
_ Reconnection ofthc Service Entrance Cable, Meter Box. altela1ions 10 receptacles
and lighting fixtures d\1e to siding I soffit installaliolL Note: New Service
BntraDce Cables wlll require a separate permit.
Rec:cMection or new cirellit for the replacetm:nl of other pennanentiy wired
appliances l~.
New CirculI for the addition of Ale to 8I1/1ldJ.lItJut21 dwelling Jlllit (boUSe or the
individqaj systlmlll in a duplex or condomilJiUJll). includiDg requimI service
electrical outlels.
Olher
ThnalueofthisworidsS 60.00
I hercby verify this work will be perfonned by an employee of this company and f\u1her verify
the reconnection / inslaIlation will be done in compliance with manufacturer and Electric code
I
David A. Y ounQwirth
(Print Name of Omcee)
08/26/05
(Date)
5m