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~ CITY OF OSHKOSH No 117586
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 520 W 14TH AVE OWner JAMES F KUBASTA Create Date 12/08/2005
Contractor LARRY HANSEN PLBG Category 440 - Industrial-Interior Plan
Bathtub 0 Shower 0 Water Softner 0 Wait.SI. 0 Shamp Sink 0 Coffee Maker 0
Whirlpool 0 Floor Drain 1 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory 1 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
Toilet 1 Disposal 0 Bidet 0 Sculry Sink ----.2 Wash Ftn 0 RPZValve 0
Res. Sink 1 Dishwasher 0 BeerTap 0 Hand Sink 0 Urinal 0 Eye Wash Statn ----.2
Bar Sink 0 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 WtrSewerMtrs 0
Water Heater 0 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
ofWork
OMM /'WAITING FOR PAYMENT CHECK # 13866 IN THE AMOUNT OF $28 IS IN THE MAIL
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 1300820000
Valuation
$1.800.00
Plan Approval
$0.00
Permit Fees
$28.00 0 Permit Voided I
Issued By
Date 12/13/2005
In the performance of this work, I agree to perform all work pursuant to ruies governing the described construction.
Whlie 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 appiicant to contact the
easement holder(s) and to secure any necessary approvais before starting such activity.
Signature
Date
Address N-1044TOWERVIEWDR
AgenVOwner
GREENVILLE
WI 54942 - 0000
Telephone Number 920-757-6863
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.