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OSHKOSH
ON THE WATER
Job Address 500-550 S KOELLER ST
CITY OF OSHKOSH
No 124020
PLUMBING PERMIT - APPLICATION AND RECORD
Owner RIVER VALLEY ONE LLC
C eate Date 04/0212007
Contractor JIM'S PLUMBING & HEATING INC
Category 440 - Industrial-Interior
Pan Y1-242-0407-P
Bathtub Shower Water Softner Wait. St. Shamp Sink Coffee Maker -
- - - - -
Whirlpool Floor Drain 2 Local Waste Ice Chest Flr/Wst Sink Int Grease Trap -
- - - - -
Lavatory 1 Lndry Tray Clothes Wshr Exam Sink Catch Basin Ext Grease Trap
- - - - -
Toilet 1 Disposal Bidet Sculry Sink Wash Ftn RPZ Valve
c... - - - - -
Res. Sink Dishwasher Beer Tap Hand Sink Urinal Eye Wash Statn
- - - - - -
Bar Sink Sump Pump Lab Sink Plaster Sink Standp Rec Wtr Sewer Mtrs
- - - - - -
Water Heater 1 Classrm Sink Sterilizer Surgeons Sink Ice Maker Deduct Meters
- - - - - -
Site Drain Breakrm Sink Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
- - - - - -
Roof Drain Ejector/Grind Drink Ftn Serv Sink 1 Soda Disp
- - - - -
Misc.
Fixtures -
Use/Nature enant space 520 S Koeller St, "Runaway Shoes" interior plumber per PLan review.
of Work
Size
Material
Type
#
Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcelld #
0611620000
Valuation
$4,000.00 Plan Approval
$0.00 Permit Fees
$42.00 D Permit Voided I
Issued By
Date 04/0212007
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 v. Drk
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 W6166 GREENVILLE DR GREENVILLE WI 54942 - 0000 Telephone Number 920-757-5258
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), )our Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is r ceived. Work may
continue if the inspection is not performed within two business days from the time the project is rea :Iy. .
15:11 FAX 920 757 6482
:::03/28/2007
:::
City of Oshkosh
INpection Services Division
POBox. 1130
Oshkosh, WI 54903-1130
Phone: (920)236-5050
Fax: (920) 236-5084
JIM'S PUtMBING
14l00l/001
() I / p~.Jv:5J
r4<'. ~ O~.tJf{ 1< ~'l ill
fhl~ Ifd" ~'d(fll
Plumbing Permit Application
I hereby apply for a permit to do and. install the following plumbing OD. the premises hereinafter described" e work toconforrn to the
Wisconsin State Plumbing Code, in the performance of which aU parties hereto agree to and are bo 'd by said statutes.
· Application(s} and foo(s) can be brought to City Hall, Room 205 Or mailed to Inspection Servi es,PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without pennit(s) will result in fees being dou ed or $100.00 plus the
normal permit fee; which ever is greater.
OR
, lcheck here,
, '(;2-Q, ;/'
'Job Address $Ft' s: ~ J? 'Val~e(Incl'!dinSlab;randmntmals) Jt./dOd" . '. ,,' Date 3/2:7 fa 7
~ . ,
Owner &./J 4zJ~ .J~ ' ' Contractor pVl1 t?! ;., ~c..
DSingle Family' . LlDuptex. DMuiti~FamilY DRental ~comin~r.tial:, [JiD.l;iustri~f'; ~.~ ~~:,:. .
Number of Fb.-tures;
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Healer --L
o ~cot 0 PwrVnt
Shower
l-'oor Drsin ~
~
~
----
Lndry Tray
1..<lbSink
Plaster Sink
Sterilizer
Misc.
Fix.tures
Electric Contractor
Use / Nature of Work
Sauitary Sewer
Stonn Sewer
Water Service
~.' ,', ",
, : . ~ ~ i
t,', :' \.'~ F~,:::\:r:s~,
Disposal
Dishvnsher
Sump Pump
Ejector/Grind
Water Softn".
Drinkrm
WaiLSt.
Ice Ch~t
E:um Sink
$cl.llry Sink
Hand Sink
F r>n:p Sink
Scrv Sink
Int Grease Trap
Ext Grease Tl':Ip
R.P.Z. Valve
Shamp Sink
Flr/Wst Sink
ateh Basifl
ashFtn
r Drain
. oda Disp
ofi'ce Maker
omm. Ice Maker
ile Drain
oof Drain
landp Rec
ye Wash Stn
ll' Sewer Mtr:i
ductMctcrs
Local Waste
Clothes Wshr
Bidet
B~Tilp
CIIL!lSTTIl Sink
Surgeons Sink
BlMknn Sink
Dip Well
Hose Bibs
-L
OR DElectric'lnstallation Verifi ation form attached
(1t Repla""rnent)
Size
Material
#
Conn. Type
Type
.:1./05