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OSHKOSH
ON THE WATER
Job Address 927 N SAWYER ST
CITY OF OSHKOSH No 128133
PLUMBING PERMIT - APPLICATION AND RECORD
Owner SUZANNE K DERR Create Date 12/12/2007
Plan
Contractor D R GLAZE PLUMBING
Category 411 - Residential-Water Heaters
Bathtub Shower Water Softner Wait. St. Shamp Sink
Whirlpool Floor Drain Local Waste Ice Chest FlrlWst Sink
Lavatory Lndry Tray Clothes Wshr Exam Sink Catch Basin
Toilet Disposal Bidet Sculry Sink Wash Ftn
Res. Sink Dishwasher Beer Tap Hand Sink Urinal
Bar Sink Sump Pump Lab Sink Plaster Sink Standp Rec
Water Heater Classrm Sink Sterilizer Surgeons Sink Ice Maker
Site Drain Breakrm Sink Dip Well F Prep Sink Gar Drain
Roof Drain Ejector/Grind Drink Ftn Serv Sink Soda Disp
Misc.
Fixtures
Use/Nature ~FR / Replace gas water heater.
of Work
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
Size
#
Conn. Type
i
Material
Type
Sanitary Sewer
Storm Sewer
Water Service
Valuation
$750.00 Plan Approval
~
$0.00 Permit Fees
$25.00 D Permit Voided I
Issued By
Parcelld #
1602930000
Date 12/12/2007
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the
easement holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
AgenUOwner
Address 1865 JAMES RD
OSHKOSH
WI 54904 - 6873 Telephone Number 920-589-4014
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
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Plumbing Permit Application
I ~ ... b' .1 pe.rmit to do .iWd iJU). following ptumbwg OR .hc prom~ hcWdIItlCr dCSCtibcd me HlK to ;;o.nfonn to lite
W~ Smto P1u,mbUtg ('.ode. in tbe petfonnalCt: afwhicltaU ~ aerctO agree ~o.., are bound b: said statuteS
. Appljcation(s) and feels) can be brought 10 CilY Hall. Room 20$ or mailed to lnspedion Sceviccs. PO BoN 1128,
Oshk<)sh Wf 54<K})..11Z& ('onwcacing WOl'k ".ithoPtpcmtil(s) will rcsult ia files being doUbled or $100.00 plug die
nonnal peOl1it &c, whieh ever is gteat.Cr.
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. DEPARTIVIENT OF
GO!1r>1LH"itrY DEVELOP~1ENT
INSPtffiON SERVICES DIVISION