HomeMy WebLinkAbout0144082-Plumbing (repair piping) a CITY OF OSHKOSH No 144082
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 400 A CITY CENTER Owner CITY CENTER ASSOCIATES LLC Create Date 11/15/2010
Contractor D.R. HANSEN PLBG. Category 442 - Commercial - Interior (New /Relocated Fixti 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 Arts for Kids / Repair pipe for existing toilet, lavatory & mop sink. * *debit acct
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
Valuation $1,100.00 Plan Approval $0.00 Permit Fees $25.00 ❑ Permit Voided
Issued By Date 11/15/2010
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 55 KNAPP ST OSHKOSH WI 54902 - 3448 Telephone Number 233 -1595
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.
11/05/2010 08:41 19202337466 DR HANSEN PLUMBING PAGE 02
City of Oshkosh
IDspection Services Division
PO Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 - 5050
Fax: (920) 236 -5084 ON E WA
Plumbing Permit Application
I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described, the WOrk tD cow 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 you Services, PO Box 1128, Oshkosh WI
54903 -1128. Commencing work without permit(s) will result in fees being doubled or 5100.00 plus the normal permit fee, which
ever is greater. -
OR
ou ' e a c . ntrac • . ar - 1. a - n • 1 he • error ; _ e cou ste /, an r av ade • . ate _ nd h . her
if you want this processed through vour account u
** Advisory - For applicable projects, an Electrical won Verification (EIV) form, sired 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
• - , for Parent Issuance and will be returned for completion.
(.2( �O ph. Da 1 10
01 7 b Address �� � a ��3cr
V (Including labor sad mataisls) 011 CO . C ° t g
(l,'{1 C Contractor 1 A � 1) It i LL .
Owner _ 1 []led
❑Single Family ODuplex OMniti -Pam m
iy ORental geomercial ustrial
Number of Fixtures:
Bathtub Stapp �p plaster Sink Root Drain
Shower sea S�nnplPraop ScaUesy sink sou. Disp
Whirlpool wear Sow serving Sisk Coe Mkr
Lavatory Standpipe Rec Ship Sink Site Dnin
Toile Osage FD Surgeon Sink Wain, Stn
Kit Sink Local Wast Sterili or Ice Chest
Disposal Bar Sink RPZ Valve Corms Ice Marl
Dishwasher Brealom Sink Bide Int Grace Crap
Floor Drain Clasum Sink [Metal Ext Ore a Trap
Hose Bibb lEm m Sink Beer Tap lire Wash Stu
Water Hester F Prep sly Dinar well Deduct Meter
0 Gas 0 l 0 pwnrvnt Floor Sink Drink Fnm wtr Sewer bar
clothes Wshr Hand S Wash Hun toot Usage Mtr
Lndry Tray tab Sunk C aeh Basin Mix Faun
Electric Contractor (for projects not requiring an EIV Form)
Use / Nature of Work 'Rt i(' Opt ( 'o l n tr 4Q i- ►G f4 /14- 04) 5;
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Received Time Nov. 5. 2010 10:00AM No.3603 06/09