HomeMy WebLinkAbout0144468-Plumbing (interior alterations) l CITY OF OSHKOSH No 144468
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1080 N WESTFIELD ST Owner EVERGREEN VILLAGE Create Date 12/27/2010
Contractor J RASMUSSEN PLUMBING INC Category 442 - Commercial- Interior (New /Relocated Fixti 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 1 Standp Rec Lab Sink Beer Tap Ice Chest
Disposal 1 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 Interior plumbing alterations at Room #212.
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 $49.00 ❑ Permit Voided
Issued By Date 12/27/2010
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.
12/24/2010 11:46 9202311289 J RASMUSSEN PAGE 01/01
City of Oshkosh
hngpectinn Services Dvi8ion
PO ex1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax' (920) 236 -5084 ( H
O rig ;, w /YtR
Plumbing Permit Application
1 hereby apply fin a permit to do and install the following plumbing on the premises hereinafter described, the work to ccmfarm to the
' Wisconsin Stale Plumbing Code, hi the performance of which all parties hereto agree to and are bound by said statute&
•* 'Applicat.ion(s) and fee(s) can be brought to City Hall, Room 205 or mailed to inspection Services, PO Box 1128. Oshkosh WI
54903 - 1128. Commencing work without permit(s) will result in .fees being doubled or $ 100.00 plus the normal permit fee, which
lever is greater.
OR
Ify6u .e •c • r art ci • iI - ., -he . P . , c• 1 steno .,.• • e ode .xra u,r.es h__ 4ere
L yo wan ib ,pr oceasg,4, hrgp&Ly_pur accnuat
4 * A.doit:ctay -• For applicable projects, an. Electrical Installaation Verification (EIV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to he performed by the lh.oreowner) must be submitted
with the permit application. Aplications satnaitted without an EIV when such is regal ed, will not be
processed for Permit Issuance and will be termed for completion.
,lob Address / a .Yo P tea- -%4 -i Value (Inctudins labor end materials) 5 --- ` pate ) 2 - Z Y—(0
Owner 6'• - 1r4m Contractor 1; 145 U - L' N P l C ,j , .1 -ac
[]Single Family ❑Duplex ,IMniti- Family DRentad DComniercial ❑Intlnstrlhal
Number of Fixtures.: .
latht+di .. Stonl pPutnp P1a+tcrSink - -- -• Roof train _ —._.-_
Shower 1 San. Sump/Pomp - -- Scni1c , Sink Soda Diap --
Whirlpnoi Water Softener Srrvic Sink Cnffoe Mkr
Lavatory _ Standpipe Rcc — Shamp Sink Lire Drain. __, --
Tnilct __i Garage Fri Surgeons Sink. �— Waits Stn _
Kit Sink 1 Local Waste • ,. Sterilizer _.. 1c* Chest
Disposal I flat pink. _ —_
RPZ Valve _ —_ Comm ice Maker
Dishwasher 1 1 marten S,nk _ Bkla int Cirnse Trnp - _,,,__,_
Floor Drain Ciaganu Sink Urinal — ......._ Lail Orman Trap _.- „_,,,. ,
Float Bibb !tam Sink . Rea Tap Rye Wash Sin ,
Water Floater F Prop Sink , .., .,__,_, Dipper Well ,_ -. ,_ Dealnet Mreer - --.
13 Use f I tient f1 PwrVnt Floor Sink ----- .Dr$nk Fin Wtr Sewer Mtr ____
Clnrbai Waits Hand Sink. _ Wash Penn Wtt Usage Mtr r ., • ,_ .,�_
Lndry Tray -- Lab Sink , „__ . Catcti Amain —Y Mine norms
Electric Contractor (for projects not requiring an EiV Form) _ ,
Use / Nature of Work . - o -tX KAa n � $ a ) , 2 _
.-- .,..., .
.,._. _. ._.. - - siyc Material Type .. # �_�V~ Conn. Type
Sanitary Sewer
Srnrm.S
Water Service
06 /0t3
Received Time Dec, 24. 2010 11:27AM No, 4173