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CITY OF OSHKOSH No 126251
PLUMBING PERMIT - APPLICATION AND RECORD
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OSHKOSH
ON THE WATER
Job Address 812 MALLARD AVE
Owner CHARLES A1MARIL YN J PERRY Create Date 08/14/2007
Plan
Contractor KOCH PLUMBING
Category 411 - Residential-Water Heaters
Bathtub Shower Water Softner Wait. St. Shamp Sink
Whirlpool Floor Drain Local Waste Ice Chest FlrlWst Sink
Lavatory Lndry Tray Clothes Wshr Exam Sink Catch Basin
Toilet Disposal Bidet Sculry Sink Wash Ftn
Res. Sink Dishwasher Beer Tap Hand Sink Urinal
Bar Sink Sump Pump Lab Sink Plaster Sink Standp Rec
Water Heater Classrm Sink Sterilizer Surgeons Sink Ice Maker
Site Drain Breakrm Sink Dip Well F Prep Sink Gar Drain
Roof Drain Ejector/Grind Drink Ftn Serv Sink Soda Disp
Misc.
Fixtures
Use/Nature MUL TI-FAMIL Y (APT #3) / REPLACE GAS WATER HEATER **debt acct
of Work
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Size
Material
Type
#
Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Valuation
~o
Plan Approval
$0.00
$25.00 0 Permit Voided I
Parcelld #
1522830000
Permit Fees
Issued By
Date 08/14/2007
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
Address 2005 DOTY ST
Agent/Owner
OSHKOSH
WI 54902 - 7040 Telephone Number 920-231-6661 or 235
Date
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.
Rug 14 07 12:29p
Clarence Koch
(920) 235-0282
p.2
City of Oshkosh
Inspection Services Division
POBox 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
(IJ
OJHKOfH
ON THE WATER
Plumbing Permit Application
I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described, the work to conform to 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, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without pennit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR .
lfvou are a contractor varticivatinr: in the Permit Fee Account System and have adequate funds. check here
i(vou want this Drocessed throUflh your account f}(3
43
Job Address zg I Z-- lI1;;tt/l,(LJ ..:5 T
Owner C'A.GJ7A /~.V 5 {'?;};1::~~'
DSingle Family DDuplcx
Value (Including labor and materials) 6t:At:J:E.!!!..
Date & - /4 -01
Contractor
DMulti-Family
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DRental
DCommercial
Dlndustrial
.i,
Number of Fixtures:
Dip Well
Hose Bibs
Drink Fin
Wait. St.
Ice Chest
Exam Sink
SculrySink
Hand Sink
F Prep Sink
Serv Sink
Int Grease Trap
Ext Grease:: Trap
R.PZ. Valve
Shamp Sink
FlrlWst Sink
Catch Basin
Wash Ftn
Urinal
Gar Drain
Soda Disp
Coffee Maker
Comm. Ice Maker
Site Drain
Roof Drain
Standp Rce
Eye Wash Sm
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Uldry Tray
Lab Sink
Plaster Sink
Sterilizer
Disposal
Di:;hwash~
Sump Pump
Ejector/Grind
Water Sl]ftner
Local Waste
Clothes Wshr
Bidet
Beer Tap
Classnn Sink
Surgeons Sink
Breakrm Sink
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
BlI!' Sink
Water Heater I
- -
Jil! Gas 0 Elect 0 PwTVnt
Shower
Floor Drain
Misc.
Fixtures
Electric Contractor
OR . DElectric Installation Verification form attached
(If Replacement)
Use I Nature of Work
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/-;.'.;;) .'.~&',./~:.:..7.,-..:>' V /"' .:.
.,<.~:.t~~
, I
".",,,,-
, "" I
Size
Material
Type
#
Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
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a t ,'i' 0.'''. ~
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11/05