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CITY OF OSHKOSH No 123219
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OSHKOSH
ON THE WATER
Job Address 206-212 W 12TH AVE
PLUMBING PERMIT - APPLICATION AND RECORD
Owner DALE M/SHERRY L HOTOVEC Create Date 12/27/2006
Plan
Contractor WATTERS PLUMBING
Bathtub Shower Water Softner
Whirlpool Floor Drain 1 Local Waste
-
Lavatory 1 Lndry Tray 1 Clothes Wshr
-
Toilet 1 Disposal Bidet
Res. Sink Dishwasher Beer Tap
Bar Sink Sump Pump Lab Sink
Water Heater Classrm Sink Sterilizer
Site Drain Breakrm Sink Dip Well
Roof Drain Ejector/Grind Drink Ftn
Misc.
Fixtures
Category 440 - Industrial-Interior
Wait. St.
Ice Chest
Exam Sink
Sculry Sink
Hand Sink
Plaster Sink
Surgeons Sink
F Prep Sink
Serv Sink
Shamp Sink
FlrlWst Sink
Catch Basin
Wash Ftn
Urinal
Standp Rec
Ice Maker
Gar Drain
o Soda Disp
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Interior remodel for new office space at 212 W 12th Ave. NOTE: Water heateris being relocated. *'DEBIT ACCT",
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer <
Water Service
Parcelld #
0901240000
Use/Nature
of Work
Valuation
$3,077.00 Plan Approval
~
$0.00
Issued By
Permit Fees
$35.00 0 Permit Voided I
Date 01/18/2007
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, if 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
Address PO BOX 118
MENASHA
WI 54952 - 0118 Telephone Number 920-733-8125
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.
~Ol/17j2007 WED 16:51
ry,
FAX 1 920 733 2713 WATTERS PLUMBING 777 City of Oshkosh
~ 0011001
Cily of Oshkosh
Inspection Selvices Divisj()n
PO Boxl130
Oshlzosl1, WI 5490:H 130
Phone: (920) 236-5050
Pax: (920) 236-5084
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Plumbing Permit Application
T hereby apply for (l permillo do and inst1ll1lhe following plumbing on .thc pl'emise~ hereinafter' described,. the work to conlcJrm to the
Wisconsin St<lt.e Plumbing Code. in the performance of which <Ill p:.1rtic~ hereto agree to and me bound by saId statutes,
I
.. Application(.s) and fee(s) Can be brought to City '-Tall, Room 20S or mailed to Inspection Services, PO Box 1 [28,
Oshko!o;h WI 54903.1128, Commencing work witham pCl'mit(s) will result in fees being doubled or $1 OO.OQ plus the
normal permit fcc. which ever IS greater,
[;2p ~ " ;).. I 'd- OR
lLy",_~!..!.,-q,.e a <",:I?..!..r..P ....,......, '~"lL in the P'?,t/JLil fo"rxfAccou.J1.C,))!};Lr,srlL(lJLd IlClve adeauCT/e funds check hf..c..t
!.f...y,(l,.U...~!:_(m t I h [S _J..:r.U,:.t.}'.' (! d I h [' (]J/J;.b.,J' 11 r ace () !!.tlCIT'-
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Job Addrcs~ 2- ()__'vV' I 2.:ih I::::Y.~~(.' ,
{-)tVl C:__Lc:, n~~.:."W_
DI>uplex OMulti-FamiJy
Owner
DSingle Family
Number of Fixtures:
l.lmhlub
Whirlpmll
LnVfll(H)'
Toilet
Re,. 'sinl\
f:lar Sink
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___..L,,,,,,,.
Willer I.kaler :.~-',']~:~:
I:; (in:; [ i l!lw , ; PwrVlIl
Shower
Floor f)1'(iil\
LtldlY Tr(~\'
Utb Sink
riMier Sillk
Sterilizer
Mis~.
Fixture:;
1=
.-1_
Electric Conf'r~\.ctOl'
Value (Including l(lborMd rnl\leriutsl... ,;,~~ ?)C~ ) 1 Oatc \ .." \.-1 '(;J"
c~i~f~\ct(H' \1V(\"'(.:.Lf1...<,,? ('I \A rhk>fV"\'\ r\ 22,.C::;,l-t.L}
,,'
DRental D(~()mmcrcial Dlndustrial
DiSI)(IS(l!
f)ishw.\sher
Sump Pl1ll1p
T~.i eel (','/Ori nd
W ~LC" Sol\llcr
l..ocnl WlIsle
Clolhes W.<llr
F.liettl
Beer '['up
CIlIs51'm !-illlk
Surgenn.; Sink
llreakrm $ink
Dip Well
Hl1se 1111.);
Dnnk Fin
Wail. 51
Ice ehe!;!
EXl\l11 Sink
Sellll)' Sink
{'hmd SlIlk
F Prep Slllk
$CI" Slllk
In( Grease Tnlp
Exl Grease Tr~p
It I'.Z, Valve
Sllmnp Sink
FlrlW~1 Silll<
Cllcch allsin
WMIlFm
Urin(ll
GllrDrain
S(,d:" Disp
eMCee, MlIker
CtJlI11l1. ICe Mi'd.er
Sile, Druin
[{nl1(" Dmin
StandI' Rec
Eye W D.sh );In
Wlr Sewer Mtr~
Deduct Meier.;
WlIl,).;ar,e MIl'S
OR
DElectl"ic Installation Verification form attached
(I r R~J)IIlt,r.lllCIlt)
Use I Nature ofWork__.,,,_
Sanitary Scwer
Storm Sewer
Walcr Service
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Size
Material
Type
tl Conn. Type
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