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OSHKOSH
ON THE WATER
Job Address 100 STONEY BEACH RD
Contractor M P KELLY
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Valuation
Issued By
CITY OF OSHKOSH
No
125761
PLUMBING PERMIT - APPLICATION AND RECORD
Shower
Floor Drain
Lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Ejector/Grind
Owner JAN VISTE REV TRUST Create Date 07/1212007
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
SFR 1 Replace tub, toilet & lavon 1st floor.
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
1414710000
$7,674.00
$0.00
$25.00 0 Permit Voided I
Permit Fees
Plan Approval
~,.o
Date 07/12/2007
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 authorityto 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
OSHKOSH
WI 54901 - 4431 Telephone Number 231-1750
Address 665 N MAIN ST
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
~
OfHKOfH
ONTHF. WATEr?
PlumbingPerl1lit Application
I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described, the work to conforrnto the
Wisconsin State Plumbing Code, in the performance of which all parties hereto agree to and are bound by said statutes.
. Application(s) and fee(s) can be brought to City Hall, Room205<ormailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work withoutpermit(s) will tesultinfeesbeing doubled or $100.00 plu~the
normal perrnitfee, which ever is greater.
OR
If you are a contractor varticipatinginthe Permit Fee Accoun.t Svstemandhaveadequatefunds. check here
ifvou want this processed through your account n
Job Addre!!S /Ot) ~ ~~"di"""''''''d'''ori''')
.Owyr ~d Vi~ Contractor
0'Single Family DDuplex DM.u..lti-Family
Number of Fixtures:
-L
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
o Gas 0 Elect 0 PwrVnt
t
~
Sterilizer
Misc.
Fixtures
Electric Contractor
Use I Nature of Work
Sanitary Sewer
.8torm.Sewer
WaterService
/'
if~;kz
Date 'I TlV.>
Dlndustrial
Disposal
Dishwasher
Sump Pump
Ejector/Grind
Water Softner
Local Waste
Clothes Wshr
Bidet
Beer Tap
ClassrmSink
Surgeons .Sink
BreakrmSink
Dip Well
DrinkFtn
Wait.St.
Ice Chest
Exam Sink
~.!<illry Sink
Haqg:?i!1~
F Prep Sink
ServSink
Jnrorease Trap
ExtG~easeTrap
R.P;Z. Valve
-Shamp Sink
F1r/Wst Sink
Catch Basin
Wash Ftn
Urinal
Gar Drain
Soda Disp
Coffee Maker
Ice Maker
Site Drain
Roof Drain
Standp Rec
Eye Wa:sh Stn
Wtr Sewer Mtrs
DeductMeters
Wtr1:)sageMtrs
. , " . '.-'
DElectriclnstaJlati Verification form attached
(If Repla<:ement)
Material
Type
#
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4/05