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to
OSHKOSH
ON THE WATER
Job Address. 3940 HEMLOCK CT
Contractor HANNA EXCAVATING
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Valuation
Issued By
CITY OF OSHKOSH
127815
No
PLUMBING PERMIT - APPLICATION AND RECORD
Shower
Floor Drain
Lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Ejector/Grind
Owner G F HOLDINGS LLC Create Date 11/14/2007
Category 401 - Residential-Exterior (laterals) Plan
Water Softner Wait. St. ----,-,l,/hamp Sink _ Coffee Maker
Local Waste Ice Chest Flr/Wst 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 -t,;,:'
~
Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
Drink Ftn Serv Sink Soda Disp
Laterals with tracer wire for NSFR.
Size Material Type # Conn. Type
Sanitary Sewer 4" Plastic Lateral 1 New
Storm Sewer 4" Plastic Lateral 1 New
Water Service 1-1/4" Plastic Lateral 1 New
Parcelld #
1282000900
$2,500.00 Plan Approval
$0.00 Permit Fees
$150.00 0 Permit Voided I
Date 11/14/2007
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 mit application within an easement, the City strongly urges the permit applicant to contact the
easement h s nd to secure atce ~ starting such activity.
Agent/Owner
Addr
Date
/I-/jI.t!Jr
OSHKOSH
WI 54904 - 0000 Telephone Number 235-6450
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
P 0 BCiX 1130
.oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
ct)
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
1 in the Permit Fee Account S
our account
** 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 :.3 9'1,1 ~/loI cI
Owner A,rfrr~
DSingle Family DDuplex
Value (Including labor and materials) ~. (j<J
Date/I" /Y'1J7
Contractor
DMulti-Family
Dlndustrial
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 Sculry Sink Soda Disp
Bar Sink Local Waste Hand Sink Coffee Maker
Water Heater Clothes Wshr F Prep Sink Comm. Ice Maker
o Gas 0 Elect iJ PwrVnt Bidet Serv Sink Site Drain
Shower Beer Tap Int 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
Sterilizer Hose Bibs Wtr Usage Mtrs
Misc.
Fixtures
Electric Contractor (for projects not requiring an EIV Form)
07/07