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0,1
OSHKOSH
ON THE WATER
Job Address 2213 MOUNT VERNON ST
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
No 127310
Contractor OWNER
Bathtub Shower Water Softner
Whirlpool Floor Drain Local Waste
Lavatory 1 Lndry Tray 1 Clothes Wshr
- -
Toilet 1 Disposal 1 Bidet
Res. Sink 1 Dishwasher 1 Beer Tap
Bar Sink Sump Pump Lab Sink
Water Heater Classrm Sink Sterilizer
Site Drain Breakrm Sink Dip Well
Roof Drain Ejector/Grind Drink Ftn
Misc.
Fixtures
Owner ROBERT R VROMAN III
Create Date 09/04/2007
Category 410 - Residential-Interior
Plan
Wait. St.
Ice Chest
Exam Sink
Sculry Sink
Hand Sink
Plaster Sink
Surgeons Sink
F Prep Sink
Serv Sink
Shamp Sink
FlrlWst Sink
Catch Basin
Wash Ftn
Urinal
Standp Rec
Ice Maker
Gar Drain
Soda Disp
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Use/Nature SFR/16' x 20'-3" addition" to include a new laundry, kitchen and bedroom. 12' x 12' deck.
of Work
I
Size
Sanitary Sewer
Storm Sewer
Water Service
Material
Type
#
Conn. Type
Valuation
$2,000.00 Plan Approval
$0.00
Parcel Id #
1515940000
Issued By
Permit Fees
$63.00 D Permit Voided I
Date 10/17/2007
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 ,;,,1 ~ It-- ;..-> Date / () -I? -O:r
Agent/Owner
Address
(2}jJ'
Oshkosh
WI 54901 - 0000 Telephone Number
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 jf the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
InspectiG!l Services Division
POBox 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
(I)
OfHKOfH
ON THE WATER
Plumbing Permit Application
[ 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
If vou are a contractor participating in the Permit Fee Account Svstem and have adequate funds. check here
ifvouwant this orocessed throurth 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 */'-vDrV Value (Including labor and materials) 2mo. c.c> Date /0 ~ 17-0;Z
.tJ!rf ;P. 0o..-nA-J Contractor ~.Pft"~t..J,d'/
DDuplex DMulti-Family DRental DCommercial Dlndustrial
Bathtub Disposal
Whirlpool Dishwasher
Lavatory Sump Pump
Toilet Ejector/Grind
Res. Sink Water Softner
Bar Sink Local Waste
Water Heater Clothes Wshr
C Gas 0 Elect lJ P Bidet
Shower Beer Tap
Floor Drain Classrm Sink
Lndry Tray Surgeons Sink
Lab Sink Breakrm Sink
Plaster Sink Dip Well
Sterilizer Hose Bibs
Misc.
Fixtures
I
~
-L
Drink Ftn Catch Basin
Wait. St. Wash Ftn
Ice Chest Urinal
Exam Sink Gar Drain
Sculry Sink Soda Disp
Hand Sink Coffee Maker
F Prep Sink Comm. Ice Maker
Serv Sink Site Drain
Int Grease Trap Roof Drain
Ext Grease Trap Standp Rec ~
R.P.Z. Valve Eye Wash Stn
Shamp Sink Wtr Sewer Mtrs
FlrlWst Sink Deduct Meters
Wtr Usage Mtrs
.e/T
r (for projects not requiring an EIV Form)
.JI~
fiA'1d,l.<J . / ;~/'
, .
1.7!A ~~ ~ ae//
/ .1'.1 a/
ft""j
Electric Contract
Size
Sanitary Sewe
Storm Sewer
Water Service
Material
Type
#
Conn. Type
07/07