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OSHKOSH
ON THE WATER
Job Address 1019 OTTER AVE
CITY OF OSHKOSH No 127728
PLUMBING PERMIT - APPLICATION AND RECORD
Owner DAVID O/JACL YN M WILSON Create Date 10/24/2007
___..-___.___._._____ _._____..____._.. ________ _.__"______ _______ 0'''-
Contractor THOMAS PLUMBING
Category ~!9_- Re~~e_':!.t!~~I~n~~o.~_~_____~_____ Plan
Shower Water Softner Wait. St. Shamp Sink Coffee Maker
Floor Drain Local Waste Ice Chest FlrlWst Sink Int Grease Trap
Lndry Tray 0 Clothes Wshr Exam Sink Catch Basin Ext Grease Trap
Disposal Bidet Sculry Sink Wash Ftn RPZ Valve
Dishwasher Beer Tap Hand Sink Urinal Eye Wash Statn
Sump Pump Lab Sink Plaster Sink Standp Rec Wtr Sewer Mtrs
Classrm Sink Sterilizer Surgeons Sink Ice Maker Deduct Meters
Breakrm Sink Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
Ejector/Grind Drink Ftn Serv Sink Soda Disp
outdoor silcock
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature SFR 1 City rehab /Install vacuum breakers on bsmt hose bibs, repair water line leak and replace outside silcock, ~repair shower fixturesinP---
of Work Ilower bath, and fix vent for lower bath shower drain.
L.
____..J
#
Conn. Type
Size
Material
Type
Sanitary Sewer
Storm Sewer
Water Service
Parcelld #
0802440000
$0.00 Permit Fees
$35.00 Q!ermit V~~dedJ
Valuation ___~€)OO.OO Plan Approval
Issued By
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 ern'1;t application within n easement, the City strongly urges the permit applicant to contact the
easement hold r s) a to secure any c sary approvals before starting such activity.
Signature iJ//f/'" Date /1 -6'.....() 7
AgentlOwner
Oshkosh
Date 11/08/2007
WI 54901 - 0000 Telephone Number 232-0094
Address 849 VINE ST
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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.
City of Oshkosh
Inspection Services Division
POBox 1130
Oshkosh, VVI54903-1130
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
l~~OU are a contractor participating in the Permit Fee Account System and have adequate funds, check here
Z- _ou want this orocessed through your 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.
JII IJ ~ d/ ;1 .6 (,
Job Address IOI? r.-;tcf' Value (Inc1udinglaborandmaterialS5"~ ,C;;? (JOt Date 1'1-.'?- 277
,
Owner Dtt-ve ~ 7J,tcl~lA tJil S bt-) Contractor Pe.pp 4L-r KekIJ de li'1 .- 'f fvtrtvrttS PllJtv-..b'hJ
WSingle Family DDuplex DMulti-Family DRental DCommercial Dlndustrial
Number of Fixtures:
Bathtub Disposal Drink Ftn Catch Basin
Whirlpool Dishwasher Wait.St. Wash Ftn
I
Lavatory Sump Pump Ice Chest Urinal
Toilet Ejector/Grind Exam Sink Gar Drain
Res. Sink Water Softner Sculry Sink Soda Disp
Bar Sink Local Waste Hand Sink Coffee Maker
Water Heater "- Clothes Wshr ~ F Prep Sink Comm. Ice Maker
-6lGas [] Elect 0 PwrVnt Bidet Serv Sink Site Drain
Shower X. Beer Tap Int Grease Trap Roof Drain
Floor Drain Classrm Sink Ext Grease Trap Standp Rec X. '3 _JWl...~-l-
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
Sterilizer Hose Bibs I~ Wtr Usage Mtrs
Misc.
Fixtures
Electric Contractor (for projects not requiring an EIV Form)
Use / Nature of Work CktJ--f11e b...b.-kr ~{ fVlpIIW... CI(f~~' &J~h.ir;, -hf. >/wwe.r J]rCt.ilt .'ee.pkt.e HtJ9Lh~kh
Size
Material
Type
#
Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
07/07