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OSHKOSH
ON THE WATER
Job Address 315 FULTON AVE
CITY OF OSHKOSH No 125718
PLUMBING PERMIT - APPLICATION AND RECORD
Owner LAVERNE PAULUS Create Date 07/10/2007
Plan
Category 411 - Residential-Water Heaters
Contractor MERTEN PLUMBING
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Shower Water Softner Wait. St. Shamp Sink
Floor Drain Local Waste Ice Chest FlrlWst Sink
Lndry Tray Clothes Wshr Exam Sink Catch Basin
Disposal Bidet Sculry Sink Wash Ftn
Dishwasher Beer Tap Hand Sink Urinal
Sump Pump Lab Sink Plaster Sink Standp Rec
Classrm Sink Sterilizer Surgeons Sink Ice Maker
Breakrm Sink Dip Well F Prep Sink Gar Drain
Ejector/Grind Drink Ftn Serv Sink Soda Disp
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
SFR /INSTALL GAS WATER HEATER "check #9898
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcelld #
1000270000
Use/Nature
of Work
Plan Approval
$0.00
$25.00 D Permit Voided I
Valuation $1,253.00
Issued By ~
.......,
Permit Fees
Date 07/10/2007
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 yvhich 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
Address 1076 COZY LN
Agent/Owner
OSHKOSH
WI 54901 - 1404 Telephone Number 231-6795
Date
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.
City of Oshkosh
Inspection Services Division
POBox 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
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Plumbing Permit Application
I hereby apply for a pennit to do and install the following plumbing on the premises hereinafter described, the work to confonn to the
Wisconsin State Plumbing Code, in the perfonnance of which aU parties hereto agree to and are bound by said statutes.
· Application(s) and tee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
Ifvoll are a contractor participatinf? in the Permit Fee Account System and have adec/Uate funds, check here
ifvou want this processed through vour accoUI1! n
Job Address .3/ Value (Including labor and materials) I ~ 53. ()() Date~
Owner uverne.. Po..",J",s Contractor ~~ ~ ~./.
~Single Family DDuplex DMulti-Family DRental DCommercial Dlndustrial
Number of Fixtures:
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
\Vater Healer r=:
'\rGas [j Elect 0 PwrVnl
Shovlier
Floor Drain
Lndry Tray
Lab Sink
Plaster Sink
Sterilizer
Misc.
Fixtures
Disposal
Dishwasher
Sump Pump
Ejector/Grind
Water Softner
Local Waste
Clothes Wshr
Bidet
Beer Tap
Classrm Sink
Surgeons Sink
Breakrm Sink
Dip Well
Hose Bibs
Drink Fin Catch Basin
Wait. St. Wash Ftn
lee Chest Urinal
Exam Sink Gar Drain
Sculry Sink Soda Disp
Hand Sink Coffee Maker
F Prep Sink Comm. Ice Maker
Serv Sink Site Drain
Int Grease Trap Roof Drain
Ext Grease Trap Standp Ree
R-P.Z. Valve Eye Wash Stn
Shamp Sink Wtr Sewer Mtrs
FlrlWst Sink Deduct Meters
Wtr Usage Mtrs
Electric Contractor
OR
DElectric Installation Verification form attached
(If Replacement)
Use / Nature of Work
Size
Material
Type
#
Conn. Type
Sanitary Sewer
Stonn Sewer
Water Service
11/05