HomeMy WebLinkAbout0144275-Plumbing (bathroom remodel) CITY OF OSHKOSH No 144275
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1080 N WESTFIELD ST Owner EVERGREEN VILLAGE Create Date 12/03/2010
Contractor J RASMUSSEN PLUMBING INC Category 413 - Res - Interior (Replacement Fixtures) Plan
Bathtub Clothes Wshr Classrm Sink Surgeons Sink Roof Drain Deduct Meters
Shower 1 Lndry Tray Exam Sink Sterilizer Soda Disp Wtr Sewer Mtrs
Whirlpool Sump Pump F Prep Sink RPZ Valve Coffee Maker Wtr Usage Mtrs
Lavatory 2 San Sump /Pump Flr/Wst Sink Bidet Site Drain Misc.
Toilet 1 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 Apt #216 / Remodel bathroom. **debit acct
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
1608640200
Valuation $4,000.00 Plan Approval $0.00 Permit Fees $28.00 ❑ Permit Voided
Issued By al91/J/ Date 12/03/2010
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 1914 GREENBRIAR TRL OSHKOSH WI 54904 - 8887 Telephone Number 920 - 231 -1289
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.
12/03/2010 11:03 9202311289 J RASMUSSEN PAGE 01/01
City of
Impettion Say Ices Division
POBox1130
Oshkosh, Oel�kosh, WI 54403 -1130 .
t ia)
Phone: (920) 236 -5050
Pax: (920) 236 -5084 • • '
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- ON 'N6 WATER . • ' .
.Plumbin Permit Application : • .
• 1 hereby apply for a pecmh to do and install the following plumbing on the pr miiies hereinafter d embed, the wo to emr&+m to the
Wisconsin State Plumbing Code,,, in the perfommnce. of Which all parties hereto agree to and are bound by said mutes.
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* Application(s) and fee(s) can be brought to City Hail, Room 205 or mailed to Inspection Services, PC box 1128, Oshkosh WI
54903 -1128. Commencing work without permit(s) will result in fees being doubled or 5100.00 plus the normal permit tee, which
ever is greater. .
OR
if yds .Pre a cyn1rq , • • I i e ., n r . 1 r - i. c J
' _ __ ttt>ftenate f1iPids, R—srj
jhj,errwA•t e _ . • ', a,ro_ i c• •
**Advisory - For applicable projects, an Electrical Ifstaflation.Verlilcat1ion (ETV) foam, signed .by the Electrical '
Contractor or Bonseo r er (for installations allowed re be pCLfareaed by the hemostats) must be submitted
with the permit application Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance scrod will beretorted for completion.
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Job Address /0 et) A), ides4 k44 Value „,
labor and materials) o _ Dale 1 Z+ 2 -71 U
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owner EL/ ef/ — frq ; 1: 6 • Contractor .tt .. 'o,.S u S •e a. P i l , .'c- : .
❑Single Family E1Daplex [Muhl- Fancily DRentsl DConamerd*1 OTndnst l
Number of Flxture;
6othnih Sump Pump Plaster 4rnrc Root Drain
SiMn qr ... 1 _ gpn, Sump/Pump 5celkr Sink ._— Soda D1�p _.. -.—.
Whirlpool _ wpAer Softenet .- Service Shirt ,,,_•.. -_, Coffee 1 ---- --
ternary — 2 - . Standpipe Rec .__._.� Shamp Sink Site Drain
Teller -1 „-,- Gainfto F _— Surgeons Sink Warns San
'Kit Sink /.Deal Waste .. r . .
Steriiim lot Cheat .
Di apaa+i Rer Sink - RPZ Vohs __ _ Comm let Maker . ' -
nieitvuetl+es Rrcakrm Rink Shier • _,_j IM 0,139 Trap ,. —__
For Drain w , __ Mosque Sink tirinal Faa(3re Trap
Moe Bibb Pwam Sink _ Beer Tap llye Wuat t*n
water Mawr _ F Pro Sink —, r ,,. Dipper Well Deduct Mesa
L1 Cat 0 Elect fl nwrint Flom Sink °kink Fitts Wtr Sewer Mtr
Clotho wshr Rand Sink . _ ._., Wash Flinn _ Mr vM A1tr
Lndty , ,,.,_ • •• 1 4 1 3 4 4 ' ” • " Catch Soh' ' • ' Mica k'Htmtes '...• •
Electric Contractor (for projects not requiring an EIV Form) •
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Use is n
Nature of Work RA- Q fl- r D 9 "" ,
_� - -- Size �....- Material _... Type it Conn. Typc
Sanitary Sewer •
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Storm Sewer ,
Water Service '
06/09
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Received Time Dec. 3. 2010 10:44AM No. 3927 .
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