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OSHKOSH
ON THE WATER
Job Address 1517 BURDICK ST
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
No
Owner RICHARD/SANDRA HACKBARTH REV TRUST Create Date
Contractor SAMMONS PLUMBING
Category 410 - Residential-Interior Plan
Water Softner Wait.St. Shamp Sink - Coffee Maker
Local Waste Ice Chest FlrlWst Sink Int Grease Trap
1 Clothes Wshr Exam Sink Catch Basin Ex! Grease Trap
- -
Bidet Sculry Sink Wash Ftn RPZ Valve
Beer Tap Hand Sink Urinal Eye Wash Statn
Lab Sink Plaster Sink Standp Rec Wtr Sewer Mtrs
Sterilizer Surgeons Sink Ice Maker Deduct Meters
Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
Drink Ftn Serv Sink Soda Disp
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Shower
Floor Drain
Lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Ejector/Grind
REPLACE LAUNDRY SINK WITH AIR ADMINTANCE VALVE "DEBIT ACCT
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcelld #
1501580000
Use/Nature
of Work
Valuation
Issued By
$600.00
Plan Approval
$0.00
$20.00 0 Pennil Voided I
Permit Fees
Date 05/03/2006
In the perlormance of this work, I agree to pertonn 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 perlonn the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the
easement hoider(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Address 522 W. MURDOCK AVE
Agent/Owner
OSHKOSH
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.