HomeMy WebLinkAbout0143675-Storeage Tank (remove 1 UST) CITY OF OSHKOSH No 143675
OSHKOSH STORAGE TANK PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2815 OREGON ST Owner PAUUDARRELUSTEVEN THOMA Create Date 10/15/2010
Contractor ENVIRONMENTAL SERVICES PLUS Category 281 - REMOVE STORAGE TANKS
Tank Type • Metal 0 Fiberglass Tank Size 5000 Tanks
Service 0 Install • Remove 0 Above Ground • Underground
Contents ❑ Petroleum ❑ Solvent ❑ Natural Gas
❑ Kerosene ❑ Liquid Petroleum ® Other
Use /Nature REMOVE (1) UNDERGROUND STORAGE TANK USED FOR FUEL OIL
of Work
Valuation $4,553.00 Permit Fee Paid $100.00
Issued By: _ V Date 10/18/2010
❑ Permit Voided Parcel Id # 1413420000
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature o -) `� /� � Date / `T //6
Agent/Owner
Address 4450 FIELDCREST DR KAUKAUNA WI 54130 -4539 Telephone Number (920) 766 -6756
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.
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.
CITY OF OSHKOSH UST /AST PERMIT CHECKLIST
Job Site Address: 2815 Oregon St.
Contractor: Environmental Services Plus
Address: 4450 Fieldcrest Dr.
Kaukauna, WI 54130
Phone #: 920 - 766 -6756 FAX #: 920 - 759 -4504
AST UST X
Install Remove X Upgrade Tanks /Piping
Number, Size, & Contents of Tank(s):
1 -5000 gallon fuel oil
Tank(s) Composition: Steel
Piping Composition: Steel
Cost of Job: $4,553
Approximate Start Date: 10/18/10
Permit Issuance Approval: YES X No
Conditions of Approval: Per WI Department of Commerce COMM 10
Approved by: .•n Hol nd, LPO
Signature: � �_ i � `\ ' Date: Oct 18, 2010
Tank System Fee: $100 Plan Review Fee: Permit Fee: $100
PLEASE NOTE: THIS IS NOT A PERMIT. To obtain the required
permit, present this checklist, along with a check made payable
to the "CITY OF OSHKOSH" for the amount listed in "Permit Fee"
(above) at the Building Inspection Office, Room 205 at City Hall,
between the hours of 7:30 -8:30 AM and 12:30 -1:30 PM; or by
appointment (920) 236 -5045. This permit shall be obtained and
on - site prior to the commencement of any work.