HomeMy WebLinkAbout0126891-Plumbing (storage tank system)
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OSHKOSH
ON THE WATER
Job Address 725 BUTLER AVE
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
Owner WINNEBAGO COUNTY
Category 441 - Industrial-Water Heaters
Contractor FULL SPECTRUM SOLAR
Shower Water Softner Wait. St. Shamp Sink
Floor Drain Local Waste Ice Chest Flr/Wst 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
3
No 126891
Create Date 09/20/2007
Plan
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature Install potable water solar storage tank system as part of new Parkview Health facility per State Plan Approval dated 09/10/2007.
of Work
I
Valuation
Size
#
Conn. Type
Parcelld #
1529500000
Issued By Date 09/20/2007
Material
Type
Sanitary Sewer
Storm Sewer
Water Service
$113,200.00 Plan Approval
$0.00 Permit Fees
$25.00 D Permit Voided I
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 wit. an easement, the City s ongly urges the permit applicant to contact the
easement holder(s) an t ure a neces r als bef r starting such activity.
Signature Date r; - ;70-- "Z-oo 7
Address 100 S. BALDWIN ST, SUITE 101
MADISON
WI 53703 - 0000 Telephone Number 608-284-9495
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) 236-5050
Fax: (920) 236-5084
~
OfHKOfH
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 InspectionServices, 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
If vou are a contractor participating in the Permit Fee Account Svstem and have adequate funds. check here
if vou want this processed through vour account n
** Advisory - For applicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by the homeowner) must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
Job Address 7;Ls- jlu tier
Ownerl^),' (I r1 e &~l> CD
DSingle Family DDuplex
Contractor
DMulti-Family
Value (Including labor and materials) f/3. t.()O;/
r:l{,-/I S e c~
DRental
Date
cr - J.(r 07
Number of Fixtures:
Bathtub Disposal Drink Ftn Catch Basin
Whirlpool Dishwasher Wait. St. Wash Ftn
Lavatory Sump Pump Ice Chest Urinal
Toilet Ejector/Grind Exam Sink Gar Drain
Res. Sink Water Softner Scu]ry Sink Soda Disp
Bar Sink Local Waste Hand Sink Coffee Maker
Water Heater Clothes Wshr F Prep Sink Comm. Ice Maker
C Gas C Elect [] PwrVnt Bidet Serv Sink Site Drain
Shower Beer Tap lnt Grease Trap Roof Drain
Floor Drain Classrm Sink Ext Grease Trap Standp Rec
Lndry Tray Surgeons Sink R.P.Z. Valve Eye Wash Stn
Lab Sink Breakrm Sink Shamp Sink Wtr Sewer Mtrs
Plaster Sink Dip Well Flr/Wst Sink Deduct Meters
S teri I izer Hose Bibs Wtr Usage Mtrs
Misc.
Fixtures ~
Electric Contractor (for projects not requiring an EIV Form)
Use / Nature of Work
3 5o/.;Ai<- SfOr<A bE -ptAfk~
Size
Material
Type
#
Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
07/07
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09/06/2007 10:57 FAX 715 842 9059
'~WAtJSAU CHEMICAL
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REGfSTERE[)
August 28, 2003
RECEiVED
SEP 1 0 200?
SAFETY & BUILDINGS
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Ardmr PIasbinski
W AUSAU CliEMICALCOJU'ORATION
P.O. BOX9S3
2001 N. RIVBRDR.
. WAUSAU. WIS4403
UN1T.ED STArns
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Category Code: UTI
NSF~No. 126441
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.:;(?,;~~~}~~~1~i~~~,;8~i94P~ltaS;;~9Iar..sd~trols have
beep.;*Re<;:ifIca!'Y.~esi!;ln.~d }9reg~l~tesOlar . thermal
c~lIectir sYS!rTS'i\(T"e~.~ systeh-i~trycJLJde:. open loop
.. wlthout/fr.e~~E!; pt()tection.... clpsedl(:j6p ..with a heat
. exchangf'l[,: ~r~i~,9~<;:~.'syster'nsaJ1cl.re~circulating freeze
protectecli,~ystems!.:'i,........ . ..' '.. . .... "i,'?:
EaC~'S8P#ClH~rhassiXBIr'switchesfor quick
adaptatiorto'm()r~specificaIlY' match the . controlled
system ahdc.()lIector environment. . The PlT~84 is meant
for ha~d~""ireid installation to the power sup'ply and pump;
the DlT~94 has an easy plug-in line cord to the power
supply and an outlet fpr}he pump powersupply.
Each controller model requires twoSAS-10 (10,000
Ohm) thermistor temperature sensors for operation. The
collector sensor doubles as the freeze re-circulation
sensor making a third sensor obsolete. .
This installation guide should be carefully followed for
ease of installation and trouble-free operation.
CONTROllNSTALLA TION
These controllers conform to the National Electric
Code and. prevailing local codes and should be installed
by a qualified electrician.
CAUTION: Turn off electricity at the main fuse box
before proceeding with installation of the OlT-84.
Mounting
Mount the controller on a wall indoors where it will be
away from weather and electric sources, including the
pump that it controls. The control should be mounted on
the pre-fabricated mounting. hooks at the top and bottom
of the control box as seen in the DlT-94 below.
PICTURE 1. DTT-94
Revised 9/06 MS
Power Wiring
This controller works with 120 VAG power. See the
controller layout in figure 1. The DlT-94 is pre-wired for
ease of wall plug-in operation. For the DlT-84 verify the
correct voltage. disconnect the power and make the
following connections: .
1. Connect hot lead (120 VAG-black) to power
terminal strip position 5.
2. Connect switched power out (120 VAG hot to
pump) to position 2 (Normally open -N/O).
3. Connect each neutral (white) wire to either
position in 3 and 4.
4. Connect protective ground wires (green or bare)
to ground screw.
5. If desired to power a device 'on' when the
differential is 'off, connect to, N/C power terminal
position 1.
~Wi'...,\
PUMP ON
INDICATOR-:-l
POWERJ
INDICATOR
2 3 4
?fIVlI11Jf 5
~::~u:-~;.g~;6'..IN . 1,\
I COMMON ... . Aj~
BLACK -120 VACOUT '--3. ~
NORMAlLY CLOSED ---"tJ t.
,.,"", '"""""" ~"",. I S J
Option Switch Settings and Functions lJ II
'See DIP Switch Designations in figure 2. A.tfh. /1(,' R.~y
. Switch 1 is factory set to 'on'. This meahs the pump
Will turn off when the storage tank temperature reaches
either 180eF or 160eF. depending on what is set for switch
4. In the 'off' position, there is no high limit shutoff.
Switch 2 is factory set to 'on'. This'allows.the
collector fluid to circulate when the temp,eraturegets
below 42eF to prevent freezing. This switgh overrides
switch 3.' ..'..../ .. ............,
. Switch 3 is factory set to 'on'. While on, the pump ~
Will shut off whenever the collector fluidtemperature gets V:>
below 80eF to prevent further cooling of the stored liquid, 'V
.......,.. ~
Wdb? V pj - 3Z ~l.f:(:>)' B -"f' ~ ~
i 4. f)~,; \')1..b'" 1 b fJf 1,1~\.\: '\J
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N.C. N,O,
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-=-.
Switch 4 is factory set. 'off' .anq. IS . thetligh limit
temperature setting. When off, there is a 180QF high limit.
and when on, there is a 160QF high limit. This setting is off
when switch one is off. .
Switch 5 and 6 work together and. are both. factory
set 'on'. With both 'on', the pump will turn onat9QFand
off at 4QF temperature differentials. Both switches 'off' turn
the pump on at 18QFand off at 52\ tempdiff.~renti~ls. The
on settings will benefit those in milder climates while the
off settings will benefit those in the colder climate. areas.
No High Limil_
Freeze Recirculation Off -'--
"Off Below 80oP' Off -
High Limit Setting = 1800F _
1S'FI5'F Differential Seledion C
--ON
c={J1
c={J 2
c={J 3
C!:::::J 4
c={Js
c={J 6
- "Off 8elowSOOF" On
- High Umlt SeUing = 160'1'
==:J 9'F14'F Differenlial Selection
-:..- High Umit
~ Freeze Recirculation
fiGURE 2. DIP SWITCH SETTINGS
SENSOR INSTALLATION
'See Sensor Pos.itions in figure 3.
The Sensor leads are 24 GA CLASS 2 wiring and
carry 4 VDC. Use a conductor 18-24 GA zip or bell wire to
run from the sensor location to the controller. Shielded
sensor wire is not necessary.
Slide pipe clamp over sensor and pipe and tighten.
Use caution not to damag,e sensor from over tightening.
Install insulation over the sensor and pipe combination to.
ensure accurate fluid temperature readings; wrap the
insulation with duct tape to secure.
Collector Sensor
Attach one SAS-10 sensor to the outlet of the
collector array as close to the collector as possible. This
is the high temperature sensor and also doubles as the
freeze re-circulating sensor.
The collector sensor will undoubtedly be exposed to
weather and .must be completely isolated from the
environment to better detect the outlet temperature of the
collector fluid. Cover this sensor with waterproof thermal
insulation to avoid bad readings.
Storage Sensor
This sensor is the low temperature differential and
must be attached as fow as possible to the bottom of the
storage tank. If there is no stud for the sensor, install at
supply pipe on the tank. This is the high limit shutoff
sensor. .
fiGURE 3, SENSOR POSITIONS
Revised 9/06 MS
CAUTION: The high limit function is not. UL approved
as a temperature-limiting device. Water leaving the
storage tank hotter than 180QF. may cause unsafe
pressure and temperature in the water storage tank. it
may be necessary to add a redundanttemperatllre
limit control in the system to prevent risk of water
overheating.
Protection of Sensors and Sensor Wiring
The failure of sensors and sensor wiring can cause
apparent controller failure.
To prevent sensor failures:
1. Follow installation instructions of sensors detailed
above.
2. Make sure the sensors are thermally isolated
from the ambient and away from vents or other
thermal sources
To prevent wire failures:
1. Use caution when stapling wires. The insulation
can be broken causing a short or open.
2. Use caution when pulling wires. through metal
flashing as wire may be easily stripped or shorted
by sharp metal objects. .
3. Use conduit for all buried wires.
CONTROLLER SETUP
Before putting the controller into operation, perform
the 'Control Power Test' and the 'Sensor Operation Test',
outlined below, to verify components are working properly.
The sensors are connected to the controller by way of
the four-pin, plug-in connector. Use the steps below and
figures 1 and 4 to connect the sensors to the controlle"r.
1. Unplug the connector from the controller unit and
orient it as shown in.figure 4.
2. First connect the two lead-in wires from the
collector sensor to positions 1 and 2 by sliding
the wire into the retainer and tightening the
screw.
3. Repeat step 2 for the storage tank sensor,
inserting wires into slots 3 and 4.
4. Replace connector into slot and press firmly.
.
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FIGURE 4. SENSOR TO CONTROL SETUP
Control Operation
After following the setup instructions and performing
the component tests under the 'TROUBLESOOTING'
header, the controller is ready to be put into operation.
Thedunction switch on the right side of the controller
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2
'. ~h.ouI~be set in the center, 'AUTO', position for automatic
. 'pllmpcontrol. When the switch is in the 'ON' position, the
pump(s) will run continlJously, regardless of temp~rature
difference. With the. switch. in the 'OFF" position, .the
pump(s) will not run. . .
fROUBL.ESHOOtJr-ia . .' ." ...... ....
Heliotrope Thermal' Delta.-"'@controllers are simple,
troublecfree, and very reliable. All controls shipped by
Heliotrope Thermal have gone through. a rigorous quality
control process. Field experience has shown these
controllers have a low failure raJe. Performing the
following simple tests can identify most failures. If the
control and sensors pass the tests, suspect a malfunction
in the solar collector system.
Control Power Test
This test will verify the controller receives power.
Disconnect the sensors from the right side of the
controller. If bench testing a DTT-84, a test line cord must
be connected to power terminal strip positions 5 and 4
(see figure 1). Connect protective ground to the green
ground screw. For both models, plug the line cord into a
120 VAC outlet. CAUTION: HIGH VOLTAGE IS NOW
PRESENT ON THE TERMINAL STRIP.
If the left (power) LED indicator Comes on, the
controller is receiving power. If not, consult the
manufacturer.
On/Off Test
This test verifies the controller will turn on and off.
Switch the controller 'ON,' power is applied to the
Normally Open relay point, terminal 2. This may be
verified with an AC voltmeter across terminals 2 and 3. If
a pump is connected, it should turn on.
With the switch in the 'OFF' position, power is applied
to the normally closed relay point, terminal 1. This may be
verified with a voltmeter across terminals 1 and 3.
When the switch is 'ON', the pump LED indicator
should be on. If not, consultthe manufacturer.
Basic Function Test
This test verifies the BIT settings are working
correctly. The BIT switches (figure 2) for a' particular
function must be on to test for that function.
Place BIT switches 1 on and 2 off (remaining switches
can be either on or oft) Switch controller to 'AUTO,'
Allow the sensors to come to thermal equilibrium (about
one half hour.) Short the scrElWS in positions (see figure 4)
1 and 2 andthEl controller should turn on. Next, place the
collector sensor in a cup of hot water; this should turn the
controller on. With the storage sensor screws shorted
(positions 3 and 4), the controller should turn off. If the
controller does not respond to these tests, consult the'
manufacturer.
Sensor Operational Test
Thermistor Sensors
The SAS-10 thermistor' sensors should be checked
before connecting them to the controller and activating the
system. This test requires the use ofa multi-meter. .
Revised 9/06 MS 3
All SAS-1 o sensors . manufactured by Heliotrope
Thermal are compatible and should one fail, only that orie'
nEled be replaced. These sensors have a negative
temperature coefficient as shown in table 1 below.
Temperatur$.v~..Resistance Choart
'F od e (Ohms)
OPEN 00
32 0 . 32.630
41 5 25.380
50 10 19.890
59 15 15,710
68 20 12,490
77 25 10.000
88 30 8,057
95 35 6.531
104 40 5.326
113 45 4.388
122 50 3.601
131 55 2.985
140 60 2.487
149 85 2.082
158 70 1.751
178 80 1.255
194 90 917
212 100 880
SHORT NONE
TABLE 1. TEMPERATURE VS. RESISTANCE CHART
.' To start the test, first set the multi-meter to read
:"ohms, or resistance' measurement. Make sure the meter
;,is working properly to perform this test, i.e. fresh batteries,
rete. . Connect the meter leads to the two wire leads from
. the sensor. Compare the. multi-meter values with the
numbers in table 1.
If there is an open circuit, check the following:
1. The sensor lead-in wire to the sensor for a break:
in the wire. This would usually be found around
sharp metal corners or edges such as roof
flashing.
2. The sensor lead-in wire where it connects to the
sensor leads for possible disconnection.
If there is a short circuit, check the following:
1. A nail or staple through the sensor wire shorting
the leads. '.
2. Insulation that has been scraped off the sensor
wires around sharp metal edges such as roof
flashing.
3. At the sensor where it is connected to the sensor .
lead-in wire to determine if the sensor itself is
shorted.
If the multi-meter indicates a large variati.on in the
resistance reading relative to what temperature the sensor
should be reading from table 1. then a sensor failure may
have occurred. To further'test this sensor, remove it from
its position and submerge it into a glass of ice water
allowing at least 30 minutes for itto come to equilibrium.
Make sure there is ample ice and water in the mixture to
maintain freezing temperature. If the sensor has a large
variation from the Table 1 value for 329F, the sensor is
faulty.
If still not satisfied with results, place the sensor
somewhere indoors with a known working sensor. Again,
allow 30 minutes for equilibrium, and then measure the
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resistance. A larg~ vCi.riation from tab/e.'1. ancl the working
sensor reading would prove a faulty sensor.
If the sensor appears to be working after testing,
check the system plumbing and insulation,
Defective Controllers or Sensors
Any control or sensor that has been installed one year
or less and found to be defectiveafterfoHowing the
troubleshooting procedures. and performing the
operational tests, should be returned to the distributor from
whom it was purchased or returned to Heliotrope Thermal
for repair or replacement.
If the control has been in operation for longer than
one year, return the controller, postage paid, directly to
Heliotrope Thermal. The control will be repaired or
replaced and returned within reasonable time, and an
appropriate charge will be made.
Special Applications
For assistance with special applications or unusual
installations, please call or write Heliotrope Thermal.
WARRANTY INFORMATION
Heliotrope Thermal Limited One Year Warranty and
Limited Subsequent Nine Year Warranty .
Heliotrope thermal expressly warrants the Delta-T
product (Products) to be free from defects in material and
workmanship, and malfunctions and failure to perform,
under normal use and service, for a period of one (1) year
from date of installation, provided that said products have
been installed in accordance with Heliotrope Thermal's
Installation Instructions. This warranty applies to the first
retail buyer and to any subsequent owners.
. In the event that evidence cannot be provided to
indicate the date of installation, then the period of time
shall be eighteen (18) months from the date of
manufacture.
If a defect in material or workmanship becomes
evident within one (1) year, Heliotrope Thermal will repair,
or, at Heliotrope Thermal's option, replace the defective
product within a reasonable time and without charge for
parts, transportation within the U.S. or labor, In such
event, the duration of this warranty is extended while the
Product is not functioning.
If the Product contains a defect that cannot be
repaired after a reasonable number of attempts to do so,
you, the buyer, may elect either a refund of its purchase
price, or a replacement without charge. A replacement
may consist of a new or factory rebuilt product of at least
the same quality. A new warranty shall apply to any
replacement.
To obtain service on the Product, just notify
Heliotrope Thermal by phone at (510) 237-9614, or by
letter to 4910 Seaport Ave., Richmond, CA,94804, or the
installing contractor. Provide proof of purchase and date.
Should service be. requested and no defect found in the
Product, then a reasonable charge will be made for the
service.
In no event shall Heliotrope Thermal be liable for
following: 1. Conditions resulting from a defect in a
component or part that does not makeup the
Thermal Product. 2. Conditions resulting from a significant
Revised 9/06 MS
departure Heliotrope Thermal's Installation
InstrUctions. Conditions resulting from. any misuse,
abuse, negligence, weather damage.. accident. or
alteration. 4. Consequential damages SlJch as: damage to
. your property, loss onime, inconv,enienceqr.loss.of us~of>.
the Product or any incidental expenses resulting from any
breach of the express warranty. Conditions that may
OCCur in the normal operation of the Product shall not be
invoked by Heliotrope Thermal to reduce or defeat the
coverage of this warranty.
Heliotrope Thermal's liability under this warranty shall
be in lieu of all warranties of fitness and in lieu of all
warranties of merchantability. Heliotrope Thermal shall
not be liable for any incidental or consequential damages
covered by a defective product. The maximum .liability
under this warranty shall not exceed the contract price of
the Product. Some states do not allow the exclusion or
limitations of incidental or consequential damages, and
some states do not allow limitations on implied warranties.
such as that of fitness and of merchantability. Therefore
the above exclusions and limitations do not apply to you.
This warranty gives you specific legal rights, and you may
also have other rights, which vary from state to state.
Unless otherwise explicitly agreed in writing, it is
understood that these are the only written warranties given
by Heliotrope Thermal, and Heliotrope Thermal neither
assumes nor authorizes anyone to assume for it any other
obligation or liability in connection with the Product.
In addition to the preceding warranty, Heliotrope
Thermal warrants the Product when a defect. becomes
evident. after the first year warranty has expired.
Heliotrope Thermal will repair or replace the defective
Product for a reasonable charge, not to exceed 40% of the
niost recent List Price of the identical Product or its
successor at the time of return, during the next four (4)
years, and for areasonable charge, not to exceed 50% of
the most recent List Price of the identical Product or .its
successor at the time of retum, during the next five (5)
years. The product should be returned, freight prepaid, to
Heliotrope Thermal, 4910 Seaport Ave., Richmond, CA.
94804, along with the proof of installation date. If this
proof is not provided, the date of manufacture will be used.
Should required service fee not be included with return or
should defect be caused by a significant departure from
Heliotrope Thermal's Installation Instructions, misuse,
abuse, negligence, weather damage, accident or
alteration, the replacement will be returned C.O.D. with
appropriate reasonable service and shipping charges.
f
DELTA - TSOLARCONTROL TROUBLESHOOTING GUIDE
1. The pump turns on only when the controller
is set to "ON" and not when it is set to
"AUTO". .
2. The pump is on even when it is cloudy.
3. The high temperature limit on the tank shuts
off the power to the heating element but the
collector loop pump keeps running.
4. The pump turns on when there is no sun and
it is cold outside.
Solution
.
5. There is no place to hook up a redundant
freeze control sensor.
.
Verify there are two (2) 10 kOhm thermistor
sensors installed: one sensor on the hot collector
return and the .other on the bottom of the storage
tank. The storage tank sensor isa separate
sensor than the one that comes with the storage
tank. DO NOT hook up the tank's existing sensor
or heating element wiring to the controller.
For glycol systems, set bit switches 5 and 6 to
"OFF", or in the left position. For direct water
circulation, set bit switches 5 and 6 to "ON".
Verify the collector hot return temperature is
greater than the tank temperature for the set
differential. If true; this is normal operation.
Switching bit switches 5 and 6 sets the
temperature differentials (see controller manual).
Tank high limit power shut off switches typically
come on at around 170oF. Turn the high limit
switch (bit switch 1) on the controller to "ON" and
set the high limit (bit switch 4) to 1600F
A switch is factory set to "OW to avoid freezing in
pipes for systems not containing glycol. If you
have a direct water system, it is normal
operation. If you have a system containing
glycol, turn this function off by switching bit switch
2 to the right, or "OFF" position.
Set bit switch 3 to the right. This will not~allow
the pump to run at temperatures below 800F
(This does not disable freeze protection).
The collector sensor doubles as the freeze
protection sensor. The DTT controllers are not
built to control a truly redundant fre~ze control
senSor and the wiring instructions are beyond the
scope of this guide.
HELIOTROPE THERMAL
.4910 SEAPORT AVE, RICHMOND, CA. 94804
TEL: 510-237-9614 FAX: 510~237-7018
info@heliotropethermal.com
Revised 9/06 MS
5
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1
City of Oshkosh
Inspection Services Division
POBox 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
~
OfHKOfH
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 permit(s) will result in fees being doubled or $100.00 plus the normal permit fee, which
ever is greater.
OR
[fyou are a contractor participatiM! in the Permit Fee Account System and have adequate funds. check here
if you want this processed through your account n
** Advisory - For applicable projects, an Electrical Installation Verification (ElV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by the homeowner) must be submitted
with the permit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance artd willt>e returned for completion. / _ /. _
Job Address 72'5BfATur/l Ave., Value (Including labor 3lld materials) .j/13/ "2-tJo Date~
Owner W,,..~el3A-c..o e,C)(,'N-ry Contractor r-::CA.t..-L- S ?~c-nz. ~/,(.A. $OL.^ l- "o~ z..94-
DSingle Family DDuplex DMulti-Family DRental ~ommercial DIndustrial 'i~
Number of Fixtures:
Bathtub Disposal Drink Fin
Whirlpool Dishwasher Wait St
Lavatory Sump Pump Ice Chest
Toilet Ejector/Grind Exam Sink
Res. Sink Water Softner Sculry Sink
Bar Sink Local Waste Hand Sink
Water Heater --L Clothes Wshr F Prep Sink
o Gas 0 Elect 0 PwrVnt Bidet Serv Sink
Shower Beer Tap Int Grease Trap
Floor Drain Classrm Sink Ext Grease Trap
Lndry Tray Surgeons Sink R.p.z. Valve
Lab Sink Breaknn Sink Shamp Sink
Plaster Sink Dip Well FlrlWst Sink
Sterilizer Hose Bibs
Misc.
Fixtures
Catch Basin
Wash Fin
Urinal
Gar Drain
Soda Disp
Coffee Maker
Comm. Ice Maker
Site Drain
Roof Drain
Standp Rec
Eye Wash Sin
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Material
#
o
Electric Contractor (for projects not requiring an EIV Form)
Use / Nature of Work ?l> I A (" 5 -f-Q II\. ~
Size
Type
Conn. Type
DEPARTMEN OF
COMMUNITY DEVE OPMENT
INSPECTION SERVIC DIVISION
Sanitary Sewer
Storm Sewer
Water Service
w ~ VJ?
07/07
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