HomeMy WebLinkAbout0144376-Plumbing l';') CITY OF OSHKOSH No 144376
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1040 N WESTFIELD ST Owner EVERGREEN VILLAGE Create Date 12/14/2010
Contractor J RASMUSSEN PLUMBING INC Category 410 - Residential- Interior 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 FIr/Wst Sink Bidet Site Drain Misc.
Toilet 2 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 1 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 #410 / Interior remodel. * *debit acct
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
1608640200
Valuation $5,000.00 Plan Approval $0.00 Permit Fees
$42.00 ❑ Permit Voided
Issued By 6-'11/1._ Date 12/14/2010
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 11:12 9202311289 3 RASMUSSEN PAGE 01/01
City of Oshkosh
inspection SerV1CeS 1J1vI3i4T1
•
F 1tnc 1134 -
Os1,krAh, W1 5490a -1130 ' • . • .
Flione: (920) 236 -5050 •. • — ,., • r A.
Fax: (920) 236-508 ' . .. cMl IMF WATER •
Plumbing .Permit Application • .• , • ' •
• i
.... irxt .t e f lt,..,anr. nlnnii:ina iw, the premises hereinafter dmeribed the work to conform to the ,, .
I t1cS�y appi for a • Lc...c:..,.... - .: _ . .. card :,tau.trtes.
Wisconsin Steta Ptumbing Code, irn'the pexforominec of o�liich ail panics hereto agree, ta'and •cure txnm )'hy . 1 •
' • , A.pplication(a) and fee(s) tail be brought:,to City Hall, Room 205 or m criarn ailed to Inspe 9Srvices, l'4 ilox :1 i 2R; 0446.0'0 : ;�.' .' •
64903- 11.28. Commencing vvorkcsirit3►,oti't pgrmit(a) sill resah in feP.s beins doubled or 100.00'piues•tbe normal Pm' permit fee, +'Ohi tt`. ,'•. '' '
ctrcr is gmatcr. •
y 4 r! tin•tfne M 1ht$„ � Oy ram an ve adage �f�i tnd r-t .
if If you gr���.�cc��
AZ_110F d e aibro. nc r
'r* .Advisory - For applicable projects, sn Electrical Installation Verification (ETV) form, signed by the EIecttical
Contractor or Homeowner (for installations allowed to be performed by the luim ownetr) insist be� submitted •
with tilt permit application.. Applications sabtnitted without an ELY when pacbt is required, will
processed for Permit Iaqua wt and Win be wed for completion. •' • • :
� .{ s 0g Date " - '
lob Address �l o W 4J `� t e �I �111C (irLCEuaing taper and materials)
Owner II 2/` o �,w 4 � o Contractor P 1 ' Z.•-'.', C
s
DSingle Family ['Duplex M ,�'► 0. 5 Ix �, .t � N ilti- Famfty []Rental DCornnercial DItaldu tr1a!
Number of Fixtturr:
. ,:
Pi nata Sink RoarrAnin
tarlrnrh { Snmp P omp —
Shower _I ... San. Sump/Pomp Scullery Sink Soda OR!
Wbirt I ' . -, ••Wate:s4nttenci , • . Seroicm•3ink . �— 'C.ofba•Mlar, • •
_ me Sink Stu Drain
i•.�t�aWry � . 9rarttiplpnitec • '.'. ._.- -- Sham
Tni1et Garter Ft ,•-• Sinew Sink , , — Waits STA
Kit Sink �,,. f heal Wage 9tet!}bm - - -- fee (ant
Rar Sink RPZ Valve 'Conn ica�Mat
ih�poAal -._ —.—. -_. —
0ia1mashcr _ i Bracer) dt —_ S$ Bidet int Oman Trap : ,
Flnor1rMn �• Gi Urinal Fxt()rat>aeTta --
moo TRW, Ream Sink --- , axr Tap ByeWaah Sit .
W a t e r Heater F P m . Sink • . m _ Dipper Wall ' • ' • Dcd t Melee . • ' ,
::Kiss r) filed r1 Partvnt , Finer Sink ' . • _ prink trim• Wtr Sewer Ma . 1
C farlx 1 W1thr Rana Siedc — . — wean rrt M wrr Usage Mtr _ --- ,
edrv Trr+y _ -- i ab -m1c - • CetLhAaain Mlvc fbttntsa
Electric Contractor (for projects not regnbring an ETV Form) - 0
Use / Natnre of Work . 12as•0A/4 ' - ' ••
— - -- $iac 1bJaterial Type # (WOO. Type. . •
Sanitary Sewer - - • • : , I '
Storm Sewer •, ' • • Water Service '
4
. •.o,6Fas
Received Time Dec. 3. 2010 10:53AM No.3932