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OSHKOSH
ON THE WATER
Job Address 403 N LARK ST
CITY OF OSHKOSH
No
123853
PLUMBING PERMIT - APPLICATION AND RECORD
Shower
Floor Drain
Lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Ejector/G ri nd
Owner ERIKA REZENDES Create Date 03/20/2007
Category 410 - Residential-Interior Plan
Water Softner Wait. St. Shamp Sink Coffee Maker
Local Waste Ice Chest FlrlWst Sink Int Grease Trap
Clothes Wshr Exam Sink Catch Basin Ext 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
Contractor MR ROOTER OF THE FOX VALLEY
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature SFR / DIG SUMP PIT, INSTALL PUMP & LAUNDRY TRAY "*debt acct
of Work
Valuation
Issued By
Size
Conn. Type
Material
Type
#
Sanitary Sewer
Storm Sewer
Water Service
Parcelld #
1609620000
$3,500.00
?5mw
$0.00
$25.00 D Permit Voided I
Permit Fees
Plan Approval
Date 03/20/2007
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
APPLETON
WI 54914 - 0000 Telephone Number 920-687-9178
Address PO BOX 3063
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (Le. 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.
!
03/19/2007 11:15
City of Oshkosh
IDspection Services Division
POBox 1130
Oshkosh. WI. 54903,.1130
Phone: {920} :zso..sOSO
Fax.: (920) 236-5084
9206879407
MR ROOTER
PAGE 01
(I).
~R
Plumbing Permit Application
'Job Add~esli 4DS' l\J , ~. k..
OwDer ChrIS -HaMt"1.0~J
!XJSbagleFamDy . DDuplex.
Disposal ,
DiBhwuller
Sump~
~d
Wu_ Sober
Loeal Waste
Clolbos Wlih&
Bidet
8eet Tap
CIusnu Sink
SUIpOIIS SiIIk
lkcuknn Sink
nip WcIJ
HOlle Bibs
I hemby apply for a pennit 10 do and instDll1he:fi:illowing plumbing on the pR:mises ~ dcsaibed. ~ 'WOI:k to COldQnn to Ihe
Wisconsfn Stme Plambing Code,. in the per:fitlt~MCC ofwhich aJI'partifts betcto agree to and KG hound 'by said mtmes.
Saninuy Sewer
Storm Sewer
Warer Service
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
" Oshkosh WI 54903-1128. Commencing work without pcrm.it(s) will result in fees being doubled or $100.00 plus the '
nor:r.m&l permit ~ which ever is gn'J8ter. .
OR.
~~:= 'Ilr~: ~~1J~act?;. :,~iCi~~in;; ~n ~e Pl!rfit!~f:, Account SlIstein Ilnd,havtf,flll~qilat.IJ l"un(/8. check here,
WIl t s r.OCtt l "T".O h () 7' CCOtltt '_"'" '... ' . .
Valae~_"'-t"3 S:-Or;)~ , Date 5~2 1-7
Contractor -.J.A tL t () T~'" Q, v( ~..b , ~ . ,
[]Mnlti":Family . ClRental. OComm~.clJil ;, Q~(lustri~~~:;-~.;:.i, "
.~; ~ 7:. ~_ i"'~~ ~\f.L": ~ : \~;.~: :.;:
---t----
DrfDk Ftn
W~Sl
Ice Chest
Exam SWC
&miry Sink
Hand Siuk
F Prep Sink
Seno Sink
TIlt ar.:.c Tntp
Bxt exe-l'rap
R.P.z. VaM
~ Sink
Fln'Wst Sink
---------
Number of FIxtUres:
BadUub
~I -
La~tlX'y
Toilet
Res. Sinle
Bar Sink
Water Healer ------...
o Gas D EIcct 0 J>o;iiorVnt
Shower
Floor Drain
Lndry TraY.
. Lab Sink
PI.., Sink
S1enTh:cr-
-L
.. .;; . Oktch Basin
.. Wash fin
J1rinal
Gar Drain
Socia Disp
Collte Maka-
Conan. ko Mm:r
Site Dnjn
RoorDrUn
SIIImip Rtlc
Bye Wa:dt Stn
Wtr ScWI!I' M'lr.tI
Dedu;t Mete1$
Wtr Usage MIrS
Mi!lC"
Fi:l::tures
Electric Contractor OR []Electric Installation VerificatioD form attached
(If Rep1acen1Cut)
Use/NatureofWork~/b_$O)4( PiT, IAlSTALL Put4f' -!tlPnJIJDt1-4 1J2At1
Size Ma.terial Type # Conn.Type
,$ 11 In~