HomeMy WebLinkAbout2011-Plumbing (water heater) (D CITY OF OSHKOSH No 144643
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1408 W 4TH AVE Owner ERIC W VANDENBERG Create Date 01/13/2011
Contractor KELLY INSPECTION SERVICE LLC Category 411 - Residential -Water Heaters 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 Flr/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 1
Use /Nature SFR / Replace gas water heater. * *debit Kit & Pfeil acct
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
0610581000
Valuation $175.00 Plan Approval $0.00 Permit Fees $25.00 ❑ Permit Voided
Issued By o Date 01/13/2011
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.
RU. JAN, 13, 2011 10;32 AM KITZ & PFEIL OSHKOSH FAX No, 9202363348 P. 001 /001
City of Oshkosh
Inspection Services Division
POBox1130 '
® - .
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 Of -IKOJH
• 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 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
ever is greater.
OR
ou are a contractor , artici, atin v in the Permit Fee Account S stem and have a• e uate unds check here •
ifvou want this processed through your account fl
** 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 ETV when such is required, will not be •
processed for Permit Issuance and will be returned for completion. N/)�
(
Job Address 1 O g , la Value (Including labor and materiels) i A? Date f o%, 1/ D
o C- _ t A /! JJ J. • ` 4c Contractor Dm . i /4 /f, J 7) ,e .7, 502
• ngle Family ['Duplex i)UMulti- Family ['Rental ['Commercial . ❑Industrial
Number of Fixtures: • .
Bathtub Sump Pump Plaster Sink ' Roof Drain
Shower • San. Sump/Pump Scullery Sink Soda Disp
Whirlpool Water Softener Scrvice Sink Coffee Mkr
Lavatory Standpipe Re; Shamp Sink Site Drain
Toilet Garage FD Surgeons Sink Waltrs Stn
Kit Sink Local Waste Sterilizer Ice Chest
Disposal Bar Sink RN Valve Comm Ice Maker •
Dishwasher Break= Sink Bidet Int Grease Trap
• Floor Drain Classrm Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap • Eye Wash Stn
Wate atcr / • P Prop Sink Dipper Well Deduct Meter
a❑ Elect ❑ PwrVnt Floor Sink Drink Fnm Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fan Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures
O 1
Electric Contractor (for projects not requiring an ETV' Forms) / 1
•
Use / Nature of Work •
..-
Size . Material • Typo # • Conn. Type
Sanitary Sewer }
Storm Sewer
Water Service
•
Received Time Jan. 13. 2011 10:22AM No. 4362 06/09