HomeMy WebLinkAbout0142153-Plumbing (laterals) I CITY OF OSHKOSH No 142153
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1871 STILLMAN DR Owner CORRIM COMPANY LLC Create Date 07/21/2010
Contractor IMMEL, ROBT J EXCAVATING INC Category 430 - Industrial - Exterior (Laterals) Plan
Bathtub Clothes Wshr Classrm Sink Surgeons Sink Roof Drain Deduct Meters
Shower Lndry Tray 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 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 Replace existing water lateral with a new 8" lateral for proper fire sprinkler sizing modifcations for new tennant
of Work Oshkosh Truck Corp. * *Owner of property is listed as Dyson /G GRD C Trust Charles H. per GIS. **
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service 8" Plastic Lateral 1 Relay
Parcel Id #
1225000100
Valuation $30,000.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided
Issued By Date 07/21/2010
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
44...s.....z
easement holder(s) and to secure any n essary approvals before starting such activity.
Signature /
Date 7 ) /-- /
Agent/Owner
Address PO BOX 135 GREENVILLE WI 54942 - 0000 Telephone Number 920 - 757 -5906
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.
City of C hkosh
Inspection Services Division
PO Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 Of HKOf H
ON THE WATER I I
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 participating in the Permit Fee Account System and have adequate funds. check here
if you want this processed through your account fl
** 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 ) 7 i S + 11 iTx ti Pt. Value (Including labor and materials) 30 >' O 0 . 00 Date 7 -) / - /
Owner 0. o, t. Tr,A , L en r Contractor P. S . .-1— n, r, c. / r)(4-
t, K
['Single Family ❑Duplex ❑Multi -Family Rental Commercial
Y ❑ � ❑Industrial
Number of Fixtures:
Bathtub Sump Pump Plaster Sink Roof Drain
Shower San. Sump/Pump Scullery Sink Soda Disp
Whirlpool Water Softener Service Sink Coffee Mkr
Lavatory Standpipe Rec Shamp Sink Site Drain
Toilet Garage FD Surgeons Sink Waitrs Stn
Kit Sink Local Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher • Breakrm Sink Bidet Int Grease Trap
Floor Drain Classrm Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap Eye Wash Stn
Water Heater F Prep Sink Dipper Well Deduct Meter
0 Gas 0 Elect 0 PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures
Electric Contractor (for projects not requiring an EIV Form)
Use / Nature of Work •
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service 6 P /Gt fi Ze.+ , / / f41 . 7
/, 06/09
4 ► LA 193
WATER DISTRIBUTI N JOB REPORT
WARD: j DATE: /' 28---/O
DHL #:
�j ,fin TIME OF LEAK:
LOCATION: / v 7 / 51)1/ A I4'1 # of GALLONS LOST:
WORK DONE: Che G er / 1;-;(., 4 1/111-- HYDT #:
✓ // VALVE #: / dC 6S I
SIZE:
.&gr / MK P_ .P,c 4 MAKE:
VALVE TURNED
SIZE & MAKE TURNS
V #:
V #:
INV #: QTY: PARTS: V #:
/1,1 QA 05 v #:
v #:
v #:
MEASUREMENTS: /
0/4114 iyo9 fof
/O # of 5
(>�� PERMIT: A/47 REMARKS: Ri / 4 v t'C BLACK DIRT: YES Ol
I e-
I h TO ��, r REPAIRS REQUIRED
(J ' / n // APRON TYPE:
R ef/4/z o V a /UG (,✓ /76 � CONCRETE
/ ASPHALT /HOT MIX n
V U) V e_ ASPHALT /COLD PATCH n
STREET SURFACE:
CONCRETE
GRAVEL: ASPHALT a
ASPHALT /CONCRETE n
WORKERS: # of SIDEWALK SQUARES n _At
wbND C/3425