HomeMy WebLinkAbout0100495 POSHKOSH
ON THE WATER
,Job Address 1755 #B MARICOPA DR
Contractor M P KELLY
Bathtub 0 Shower
Whirlpool 0 Floor Drain
Lavatory 0 Lndry Tray
Toilet 0 Lndry Stndp
Res. Sink 0 Disposal
Bar Sink 0 Dishwasher
Water Heater 1 Sump Pump
Site Drain 0 Classrm Sink
Roof Drain 0 Breakrm Sink
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
Owner HELENJGROENEVELD
Category 411 - Residential-Water Heaters
0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0
0 WaterSoftner 0 Drink Ftn 0 ServSink 0
0 Local Waste 0 Wait. St. 0 ShampSink 0
0 CIothesWshr 0 Ice Chest 0 FIr/Wst Sink 0
0 Bidet 0 Exam Sink 0 Catch Basin 0
0 Beer Tap 0 SculrySink 0 Wash Ftn 0
0 Dent. Oper. 0 Hand Sink 0 Urinal 0
0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
No 100495
Create Date 03/28/2003
Plan
Gar Drain
Soda Disp
Coffee Maker
Int Grease Trap
Ext Grease Trap
Use/Nature SFR/Replace gas water heater.
of Work
Valuation
Issued By
Sanitary Sewer
Storm Sewer
Water Service
Size Material Type #
$558.00 Plan Approval $0.00 Permit Fees
Conn. Type
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$20.00
Date
03/28/2003
Permit Voided
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 665 N MAIN ST OSHKOSH WI 54901 - 4431 Telephone Number
231-1750
Inspection Se~ces Division
P O Box 1130
Os~osh, WI 54903-1130
Phone: (920)236-5050 ~zo, ,s O/HKO/H
Fax: (920) 236-5084
Plumbing Permit
[ hereby appiy for a pe~t to do a~d ~staH ~c following plumbing o~ the p~e~ses he~cimftc~ described, ~e work to co~o~ to the
Wisconsin State Plumbing Code, in thc perforce of which all pa~cs hereto a~cc to a~d a~c bo~d by said sta~tcs. ·
Application(s) ~d fcc(s) ca~ be brought to Ciff HaH, ~oom 205 o~ marled to ~spcctio~ S~Jces, ~O Box 1
Oshkosh WI 54903-1 ~28. Commencing work without pc~it(s) will rcsu]t m fees being doubled o~ $~00.00 plus thc
no~al pe~it Eec, which eve~ {s ~eaten
OA
i~you are a contractor participating i~ the Permit Fe~ ~cco~nt EVstem a~g ha~e ageq~ate ~u~gs, c~ecA here
~o~ want this processeg throug~ your account ~
Owner ~~ ff~~ Con tractor ~ ~ ~//~;
~ngle Family ~Duplex ~Multi-Family ~Rental ~Commereial ~Indu~triai
Number of Fixtures:
Bathtub Lndry Standp Dent. Oper. Shamp Sink
Whirlpool Disposal Dip Well Flr/Wst Sink
Lavatory Dishwasher Drink Fm Catch Basin
Toilet Sump Pump Wait. St. Wash Fm
Res. Sink Ejector/Grind Ice Chest Urinal
Bar Sink Water Soffner Exam Sink Gar Drain
Water Heater / Local Waste Sculry Sink Soda Disp
TanS'as E Elect [] PwrVnt Clothes Wshr Hand Sink Coffee Maker
Shower Bidet F Prep Sink Ice Maker
Floor Drain Beer Tap Serv Sink Site Drain
Lndry Tray Classrm Sink Int Grease Trap Roof Drain
Lab Sink Surgeons Sink Ext Grease Trap Standp Ree
Plaster Sink Breakrm Sink
Sterilizer
Electric Contractor
' Nature of Work'
Use /
Sanitary Sewer
Storm Sewer
Water Service
Size Material
O-R [-']Electric Installation Verificati6n form attached
(If R~placement)
Type # Conn. Type
3/02