HomeMy WebLinkAbout0144475-Plumbing (interior alterations) CITY OF OSHKOSH No 144475
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1080 N WESTFIELD ST Owner EVERGREEN VILLAGE Create Date 12/28/2010
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 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 2 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 #213.
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
1608640200
Valuation ,000.00 Plan Approval $0.00 Permit Fees $49.00 ❑ Permit Voided
Issued By Date 12/28/2010
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.
12/27/2010 08:37 9202311289 J RASMUSSEN PAGE 01/01
City of Oshkosh
Ittg t tinn Services DIv18itm
F O bBox 1130
Oshkosh, WI 54903-1130
. ®
i'Itone: (920) 236 -50511 ���
Fax: (920) 236-5084
(IN TrAE. WATER
• Plumbing Permit Application
1 he4r.by apply fora 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.
• Applicati*n(s) and fee(s) can be brought to City 14a11, Room 205 or mailed to Inspection Services, PO Box 1128, Oshkosh Wl
:54903-1128. Commenting work without permit(a) will result in foes being doubled or S100.00 plus the normal permit fee, which
darer is greater.
O
ifYjai/ a r e g conttractor � g r E i c i p p _ a 2 , � i t A cc t7.L,^,E'Cier an¢ larva adea e a .heck here
if vou_}yant tlti.€ pr ocess .d ror!gh- kour arc t
** Advisory - For applicable projects, an Electrical. Installation Verification (ETV) form, signed by the Electrical
Contractor or Homeowner (for installations allowed to be performed by time homeowner) must be submitted
with the permit application. Applications submitted without an EIV when such is 1regvlred,, will not be
processed for )Permit Issuance natl will be returned for completion -
G�4S.f'T+ 4 Value (Including lobo -end matcriaka) �'— / - 2 Y /p
Job Address � � $ 0 N , m rid .,.... ... ._. Date
Owner _ e./.14- y r'.rfr` Contrador R. t, o ►... u s s •e,..+ P l , ;r C . .
['Single Family DDuptelr Mniti Fs m�ifly Dkental DCnmmtr+ete) DIn
Number of Fixtures: .
Bnti,t,tt+ __ _„ _ Sutrm Pump - -- -, Plainer Sink Roof Drain _
Sl,nwcr - -• Win. 8ump11'meP —_- Scullery Sink Salop -- Whirlpnnl — _ Water softener rvice Si nk Coffee Mkr _
i.:wat 2 - .� Standpipe Roc Sharnp Sink _.. ;Cit Drain
arY
Teikx . 1 Clomp PD Surgeons Sink. Waitrt St _
Kir, Sink _ I Load Wade —• �, S
R terifiacr T __ Yee Chart _�
1>i5lrnsal �
Bar Sink .P7. Valve - -• -• iwammk Maker
1 Brcakrm Sink Bidet int atone Trap -- Nahurasher --
Floor Amin--- C1naerm Sink Urinal - _, • Fart Greene Trap —_
t10 a Bibb ,.. !'..tom Sink ,, Tap Eye Wash Sis
Water Heater -- F rrep Sink . _.— Dipper Well . —__ Deduct Meter —_
f l cioa I.l Elam n Pwrvro Floor Sink ---_ Drink !kiln Wm Sewer Mir . ---
Clotb Wchr Hand Sink _.. __ WaA11 Firth __ Wu linage - - -
IAdry Tray T. Sink Ouch Baein — _ MiRC Pixiu, _,. —
k lccteic Contrra.ctor (for prgjee s not requiring an ETV Form) Use / Nature of Work f?,../... ►..o k JA. 11.00.0 'bt o 2 ) 3
- -- Sibc ... Material Typo . �.� # Conn. Type
Sanitary Selmer
Storm Sewer .
Water Service
P6 /0a
Rece T Dec. 27. 2010 8:19AM No. 4177