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OSHKOSH
ON THE WATER
Job Address 347 W 17TH AVE Owner CHRISTINE J/DEBRA J PAULSEN
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
Contractor AHERN-GROSS INC.
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Category ~~O.___R~~ i~~.n_tial~l.nte!l~~..m_____.._
Shower Water Softner Wait. St. Shamp Sink
Floor Drain Local Waste Ice Chest FlrlWst 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
[SFR / Replace standard bath/shower faucet with pressure balance faucet.
I
I
No
127765
Create Date 11/12/2007
Plan
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Size
Conn. Type
Material
Type
#
Sanitary Sewer
Storm Sewer
Water Service
$O.OQ Permit Fees ____ $25:00 D Permit Voide~J
Parcelld #
1404400000
Issued By
Valuation $400.00 Plan Approval
(J~
Date 11/12/2007
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
Address
218 S MAIN ST
Agent/Owner
__ E2!':1P.[)~!-:6~ .. '/VL5~93?_ - 490~_. Telephone Number
Date
920-921-1414
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
Plumbin2 Permit Awlication
~
OfHKOfH
ON THE WATER
I hereby apply for a permit to do and install the following plumbing on the premises hereinafter descrihcd, the work to conform to the
Wisconsin State Plumbing Code, in the performance of which all parties hereto agrce to and arc bound hy said statutes.
J b Add 347 West 17th Ave. V I $ 400 00
o ress a ue (Including lahllrand matelials) .
Debra Paulsen
Contractor
Ahern-Gross Plumbing
Owner
QgSingle Family
Date 10-25-2007
Dlndustrial
DMulti-Family
DRental
DCommercial
Dnuplex
Number of Fixtures:
Bathtub Faucet 1
Whirlpool
lavatory
Toilet
Res. Sink
Bar Sink
Water llcaler
o Gas rJ Electric 1.I Power Vent
Shower
Floor Drain
lndry Tray
lab Sink
Plaster Sink
Sterilizer
Breahlll Sink
Dent. Opa
Dip Well
Drink FIn
Wait. St.
Ice Che~t
Exam Sink
Scufry Sink
Ilan<l Sink
Lndry Stalldp
Displlsa I
Dishwasher
Sump Pump
Ejector/Grind
Waler Sonner
Local Wasle
Clothes Wshr
Bidet
Beer Tap
Classnn Sink
Surgeons Sink
F Prep Sink
Serv Sink
lnt Grease Trap
Ext Grease Trap
Sllamp Sink
FlrlWst Sink
Cateh llasin
Wash Ftll
Urinal
Gar Drain
Soda Disp
ColTec Maker
Ice Maker
Site Drain
Roof Drain
Standp Ree
Electric Contractor
OR
o EIV form attached (If Replacement)
Replace standard bath/shower faucet with pressure balance faucet.
Use I Nature of Work
RECE1VED
NOV 1 2 2007
Size
Material
Type
Sanitary Sewer
Storm Sewer
$ 25.00
Water Service DEPARTMENT OF
----..-----..---- COMMUNITY DEVELOPFIENr--
T.N...SPECfION SERVICES DIVISION
. Application(s) and fee(s) can be brought to City Hall, Room-2U5 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 nonnal pennit fee,
which ever is greater.
OR
Check here i f~!:l_ w...~i.!2...~_.tJ:j.E-P.roce~~ed throu2E.Y..9_L!.!-~~coun_E 0