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City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920)236-5084
OfH~ H
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
If you are a contractor narticinating in the Permit Fee Account System and have adequate funds check here
~f you want this Drocessed through your account I-I
** Advisory -For applicable projects, an Electrical Installation Verification (Elm 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 Value (Including labor and materials) Date ~Q~
Owner S(~, me_S s -~-Cp~ ~ 1,, Contractor ~~-
,Single Family ^Duplex ^Multi-Family ^Rental ^Commercial Industrial
Number of Fixtures:
Bathtub Disposal
Whirlpool Dishwasher
Lavatory Sump Pump
Toilet Ejector/Grind
Res. Sink WaterSoftner
Bar Sink Local Waste
Water Heater Clothes Wshr
^ Gas ^ Elect ^ PwrVnt
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
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
lnt Grease Trap Roof Drain
Ext Grease Trap Standp Rec
R.P.Z.. Valve Eye Wash Stn
Shamp Sink Wtr Sewer Mtrs
Flr/Wst Sink Deduct Meters
Wtr Usage M[rs
Electric Contractor (for projects not requiring an EIV Form)
Use /Nature of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
o~/o~