HomeMy WebLinkAbout0144671-Plumbing (exam sink) CITY OF OSHKOSH No 144671
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1834 ALGOMA BLVD Owner HERMAN G SCHATZ Create Date 01/18/2011
Contractor M P KELLY Category 442 - Commercial- Interior (New /Relocated Fixti Plan
Bathtub Clothes Wshr Classrm Sink Surgeons Sink Roof Drain Deduct Meters
Shower Lndry Tray Exam Sink 1 Sterilizer Soda Disp Wtr Sewer Mtrs
Whirlpool Sump Pump F Prep Sink RPZ Valve Coffee Maker Wtr Usage Mtrs
Lavatory San Sump /Pump Fir/Wst Sink Bidet Site Drain Misc. 1
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 Dental Table
Use /Nature Lakeside Animal Hospital/ Replace exam sink and install new dental table with an approved hand shower assembly
of Work with integral cross connection protection.
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id #
1219530000
Valuation $2 0.00 Plan Approval $0.00 Permit Fees $25.00 ❑ Permit Voided
Issued By Date 01/18/2011
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 665 N MAIN ST OSHKOSH WI 54901 - 4431 Telephone Number 231 -1750
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.
y of Oshkosh M. P. KELLY, INC.
■ Box 1 Services eDivision 665 N. MAIN STREET . . .
tkosh, WI 54903-1130 OSH(OSH, 1'SC. 54901 ,e:.
one: (920) 236 -5050 14 �i 3/ / 75 — fr _., i
:: (920) 236 -5084 UN • 1
ON THE WATER JAN 1 8 2011
Plumbing Permit Application
ereby apply for a permit to do and install the fdll6wing plumbing on the premises hereinafter described, the work to cotifbiliii to the y r)1'
Wisconsin State Plumbing Code, in the performance of which all parties hereto agree to and are bound by saidtes.
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
you are a contractor pai'tictpating in the Permit Fee Account System and have adequate funds, check here
you want this processes through your account ri
Advisory - For applicable projects, an Electrical Installation Verification (ETV) form, signed by the Electrical
uttracturorHomeciwner for insta Wed t0 / 1*A:brined by the homeowner) must be submitted
ith the permit application. Applications submitted without an EIV when such is required, will not be
ocessed for Permit Issuance and will be turned for completion. It.
/ ! / r Value . iu. lab or and materi Date /_ h — ii
43 Address I �. � LL�..� �. g )
1
/ ► pEKl��
caner � o tractor
'Single Family ODuplex OMulti- Family . ORental ommercia1 DIndustrial
I 1 , I E
umber of Fixtures:
Bathtub Sump Pump Plaster Sink Roof Drain
hower San. Sump/Pump Scullery Sink Soda Disp
Thirlpool Water Softener - Service Sink Coffee Mkr
avatory Standpipe Rec Shamp Sink Site Drain
'oilet Garage FD Surgeons Sink Waitrs Stn
:it Sink Local Waste Sterilizer Ice Chest
)isposal Bar Sink RPZ Valve Comm Ice Maker
)ishwasher Breal rm Sink Bidet int Grease Trap
loor Drain Classrm Sink T Urinal Ext Grease Trap
lose Bibb Sink / Beer Tap Eye Wash Sin
Vater Heater F Prep Sink Dipper W j1 _ 'outset. ter
0 Gas 0 Elect 0 PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
;lothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr
,ndry Tray Lab Sink Catch Basin Misc Fixtures
is Contractor (for v jects not requiring an EIV Form)
Nature of Work a t t ' _ 0 ��A � .� , . ,/ ��
Size Material Type # Conn. The
Sanitary Sewer
Storm Sewer 06
Water Service .
•
• 06/09