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OSHKOSH
ON THE WATER
Job Address 1102 E NEVADA AVE
CITY OF OSHKOSH
No
126280
PLUMBING PERMIT - APPLICATION AND RECORD
Shower
Floor Drain
lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Ejector/Grind
Owner GEORGE M POUBA Create Date 08/15/2007
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 AHERN-GROSS INC.
Bathtub
Whirlpool
lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Valuation
Issued By
SFR / Replace bath/shower faucet with pressure balance faucet.
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
1511390000
$400.00 Plan Approval
a/J/U~
$0.00
$25.00 D Permit Voided I
Permit Fees
Date 08/15/2007
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
FOND DU LAC
WI 54935 - 0000 Telephone Number 920-921-1414
Address 218 S MAIN ST
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.
City of Oshkosh
Inspection Services Division
POBox 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5(150
Fax: (920) 236-5084
~
OfHKOfH
ON THE WATER
Plumbing Permit A{!plication
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 arc bound by said statutes.
Job Address 1102 E. N::va:la !we.
Value (Including labor and materials) ~.oo
Date Pug. 14, 2007
09Single Family
DDuplex
Contractor th=m-Gross Plurbing
DMulti-Family DRental DCommercial
Dlndustrial
Owner
GEOrge fu.ta
Bathtub FaJ..Cet
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
o Gas 0 Electric 0 Power Vent
-~
Sterilizer
nreaB,EC ElVED
Number of Fixtures:
Shower
Floor Drain
Lndry Tray
Lab Sink
Plaster Sink
Sump Pump
Ejector/Grind
Water Soflncr
Local Waste
Clothes Wshr
Bidet
Beer Tap
Classrm Sink
Surgeons Sink
Denl. Oper. AUG ttLO07 Ylamp Sink
Dip Wcll-FlrfWst Sink
Drink Ftn DEPARTMENT OF Catch Basin
. COMMUNITY DEVELOPMENT
wal1.1NsPECTION StRvlCES DIVISIO~sh FIn
lee Chest __ Urinal
Lndry Standp
Disposal
Dishwasher
Exam Sink
Seulry Sink
Hand Sink
F Prep Sink
Serv Sink
Int Grease Trap
Ext Grease Trap
Gar Drain
Soda Disp
Coffee Maker
Ice Maker
Site Drain
Roof Drain
Standp Ree
Electric Contractor
OR
o EIV form attached (If Replacement)
Use I Nature of Work
Replcarl r~ ffith/~ faJ..Cet w/p:BSsure 'tal.arLe faJ..Cet.
Size
Material
Type
#
Conn. Type
Sanitary Sewer
$ 25.00
Storm Sewer
Water Service
. Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128, Oshkosh W
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
Check here if you want ~hi~rocessed through your account []
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