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OSHKOSH
ON THE WATER
Job Address 1015 S WASHBURN ST
CITY OF OSHKOSH
No
126444
PLUMBING PERMIT - APPLICATION AND RECORD
Shower
Floor Drain
Lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Ejector/Grind
Owner DALVIR INC Create Date 08/23/2007
Category 440 - Industrial-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 D.R. HANSEN PLBG.
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Valuation
Issued By
Interior Remodel. "DEBIT ACCT".
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
1311920000
$3,000.00 Plan Approval
~f./:J
$0.00
$28.00 0 Permit Voided I
Permit Fees
Date 08/23/2007
In the performance of this work, I agree to perform all work pursuant to rules goveming the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the
easement holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
AgenUOwner
OSHKOSH
Address 55 KNAPP ST
WI 54902 - 3448 Telephone Number 233-1595
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
~ B8!23!2BB7 11:25 192B2337455
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fa_,. ',120; 23c.,508.t
DR HANSEN PLUMBING
PAGE B1
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Plumbing Permit Appll
: 1'.~,: '-':1/ fl,;)l:- fJr a pGrrr.it to do e.l1cJ instAll the fonowing plumbing on the premises. rei.llafter described, the work to confonn 10 the
W[sc:ol\5i.a St;lte Pl'.lJnbing Code, in the pcrfonnanc.e ofwhieh all parties ber$ IlgTcc to and a.rc:boUnd by said ,!It!\~te~.
It ,'\:i;JliC::ltion(s) i'll'"\d fce(s) can be brought to City Hall, Room 205 ormailo to Insp~ction Services, PO Box 1128, ,
':l::';,~:o;;h WI 54903,1128. Commencing work withcutpermit(s) will're t in fees being doubled or $100.00 plus L~~
: .'n1',;>.1 p.:rmit (ee, which ever is greater.
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Oi,lp(>~al
Dishwuller
Sump Pump
Ejector/Grind
Wat~r SolmQr
Ux:31 Waste
CIO\t;cs W5hr
Bidet
DrillkFm
WaitSt
Ir;c ChC~1 ' , I
Eum Sink' ' !
Sculry Sink
Hind Sink
CnlClI BlI$in
Wash F'lrl
Urinal.
Oar Drain
SOO~ Di!')>
com~~ Maker
Convn. lc~ Mak.:-r
Silc fmin
Roof Drain
SWldp Ret
Eye Wasll SI,.,
Wrr Sewer }.Il'r~
Deducl M~lers
\l.'tr Usage Mt"
r Prep Sink
Sm Sink
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Int Orc~ Trill ;
Ex.1 Greas~ Tl"llfl 11
R.P.Z. VAlve ':1
II
Shamp Sink il
FlrNiat Sink :1
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Beer TaD
CIa.lHTll Sink
~\li'~eons Sillk
f);eaknn Sihk
1.>iI'Wdl
r~o5e !3lbs
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