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Home My WebLink About0144146-Plumbing (laterals) (g) CITY OF OSHKOSH No 144146 OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 951 957 W 9TH AVE Owner KOMOROWSKI PROPERTIES LLC Create Date 11/18/2010 Contractor KELLY INSPECTION SERVICE LLC Category 401 - Residential - 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 Fir/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 Relay water service due to failure. of Work Size Material Type # Conn. Type Sanitary Sewer Storm Sewer Water Service 1" Copper Lateral 1 Relay Parcel Id # 1306000000 Valuation $2, 0.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided Issued By Date 11/18/2010 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 5097 SHERMAN RD OSHKOSH WI 54901 - 9755 Telephone Number (920) 284 -1458 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 Oshkosh Inspection Services Division P O Box 1130 Oshkosh, WI 54903 -1130 Phone: (920) 236 -5050 Fax: (920) 236 -5084 O.JHKOJH ON THE WATER 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 Servic= Is & . 11 : • ; 1 54903 -1128. Commencing work without permit(s) will result in fees being doubled or $100.00 • 1 s • , ever is greater. NO V 1 8 2010 OR If you are a contractor participating in the Permit Fee Account System and have adequarPE `AI alFfc>tt is here if you want this processed through your account f COMMUNITY DEVELOPMENT INSPECTION SERVICES DIVISION ** 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. ''�� q Job Address 5 / 1 � 17i 'r p Value (Including labor and materials) ?�j�''0 Date / J -' < Owner P41 r( c) '5 /, ` Contractor P+ z /te 7/ e.- y ['Single Family uplex ❑Multi- Family ['Rental ['Commercial ❑Industfrial 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 Waite 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 ❑ Gas ❑ 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 Pe-- /,4y • G�iq�.e-, 5,--€4. -, p Size Material Type # Conn. Type Sanitary Sewer Storm Sewer Water Service / r � `c C O p2,C / ! I 06/09