HomeMy WebLinkAbout0142013-Plumbing CITY OF OSHKOSH No 142013
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1015 BAY SHORE DR Owner WILLIAM M HOLICKY Create Date 07/13/2010
Contractor J RASMUSSEN PLUMBING INC Category 410 - Residential- Interior Plan
Bathtub Clothes Wshr 1 Classrm Sink Surgeons Sink Roof Drain Deduct Meters
Shower Lndry Tray 1 Exam Sink Sterilizer Soda Disp Wtr Sewer Mtrs
Whirlpool Sump Pump F Prep Sink RPZ Valve Coffee Maker Wtr Usage Mtrs
Lavatory San Sump /Pump Flr/Wst Sink Bidet Site Drain Misc.
Toilet Water Softner Hand Sink Urinal Wait. St. Fixtures
Kit Sink Standp Rec 1 Lab Sink Beer Tap Ice Chest
Disposal Gar Drain Plaster Sink Dip Well Comm Ice Maker
Dishwasher Local Waste Sculry Sink Drink Ftn Int Grease Trap
Floor Drain Bar Sink Sery Sink Wash Ftn Ext Grease Trap
Hose Bibb Breakrm Sink Shamp Sink Catch Basin Eye Wash Statn
Water Heater
Use /Nature SFR / Remodel laundry room with studors. **debit acct
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
0805920000
Valuation $1,50 - 0..00 / Plan Approval $0.00 Permit Fees $25.00 ❑ Permit Voided
Issued By 0,72"(-42. Date 07/13/2010
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the
easement holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 1914 GREENBRIAR TRL OSHKOSH WI 54904 - 8887 Telephone Number 920 - 231 -1289
To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
07/13/2010 12:12 9202311289 J RASMUSSEN PAGE 01/01
City of Oshkosh
inspection ServiCCSS t)1VIs10n
PO Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 • IKQ/H
ON TI-IF wATIR
Plumbing Permit Application
1 hereby apply for a permit to do and install the following plumbing on the premises hereinafter described, the work to conform to the
Wisconsin State Plumbing Code, in the performance of which all parties hereto agree to and are bound by said statutes.
e Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO 13ox 1128, Oshkosh WI
54903412$. Commencing work without permit(s) will result in fees being doubled or 5100.00 plus the normal permit tee, which
eve is greatct.
OR
/L , u a a con ractt+r aatJicipa(ing • '. t . ;;' .. cc , . gtc , .4 ' ..1 a , ?late f ...S here
if v.WA WW :gi,s_X1lQce_S.E ..th ying..q. aata. G
** Advisory - For applicable projects, an Eicctrical Installation Verification (EIV) fottm, signed by the Electrical
Contractor or Homeowner (fox installations allowed to be performed by the homeowner) most be swbmitted
with the permit application. Applications submitted without an ETV when such is required, will not be
processed far Permit Issuance and will be remised for completion.
/90 ° ° n�t� ' l 2 as
Job Addresa / 0 /5 - ‘ 1 • 11 .i. Value (tncln4inR ishor and mnmia10)) .._ —
Owner Contractor t R 0.S ►K 6, s S .e K. P 11 , I ,
[dingle Family ❑Daplcx ❑Mnttf- Family ❑Rental ❑Commercial ❑iadnatrial
Number of Fixtu
Aathnrh _ SumP Primp Fleeter Sink Roof Drain .
Shower -- . Son. Su np/Pomp ��.r -_ Scullery Sink _ -_. Soda bisp -
Whirlpool Water Softener . Service Sink — Coft Wu - -
Lentory _ _ Standpipe Ree _ i ..- Shawn Sink - ..,. -_ Site Drain
Toild Caeratm m
Curea+nk Sink Wain Stn
Kit Smk - -- Leal Waste Sterilizer .-, lac Chest
Disposal __.T_ Bar Sink R17.. Valve _ Comm Yee Maker -_
Nahwasher Breakrm Sirdc Bidet —_,- tm (keen Trap --
Floor Drntn __ Chasm Sink
Urinal FStt Orem Trap _
}ibex Bill+ _
Exam Sink - .. Baer Tap Bye Wash San _
F Frep Sink .,.,, Dipper Well Duct Mate' ""�
Water Rester, Drink 1pntn Wtr Scorer M7
U.1 Gas 0 Elect 0 PwrVni Floor Sink -- _ --w .—
Clothes Wain _L— Hand Sink _ . _ Wnah Flan Wv Vane Mtr _...,.—
i.ndry Tray_ rah Sink . --- _ Catch Basin ,�_,__ Mist Fixtures ___ r
Electric Contractor (for projects not requiring an ETV Form)
Use / Nature of Work _.2+t -,o,1 (, I-414 w• r ki . -'Jl ° -
r. - -.
Sin Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
06/00
Received Time Jul. 13. 2010 12:51PM No. 1900