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OSHKOSH
ON THE WATER
Job Address 2163 W 9TH AVE
Contractor GERRITTS PLUMBING INC
Inspector Jerry Fabisch
Bathtub
Clothes Wshr
Shower
Lndry Tray
Whirlpool
Sump Pump
Lavatory
1 San Sump /Pump
Toilet
1 Water Softner
Kit Sink
Standp Rec
Disposal
Gar Drain
Dishwasher
Local Waste
Floor Drain
1 Bar Sink
Hose Bibb
1 Breakrm Sink
Water Heater
Int Grease Trap
Use /Nature
of Work
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
No 148792
Owner THOMAS O /PATRICIA HALLQUIST REV TRUST Create Date 12/20/2011
Category 442 - Commercial- Interior (New /Relocated Fixti Plan
Classrm Sink
Surgeons Sink
Roof Drain
1 Exam Sink
Sterilizer
Soda Disp
F Prep Sink
RPZ Valve
Coffee Maker
Flr/Wst Sink
Bidet
Site Drain
Hand Sink
2 Urinal
Wait. St.
Lab Sink
Beer Tap
Ice Chest
Plaster Sink
1 Dip Well
Comm Ice Maker
Sculry Sink
Drink Ftn
Int Grease Trap
Sery Sink
Wash Ftn
Ext Grease Trap
Shamp Sink
Catch Basin
_ Eye Wash Statn
;OMM /ADDITION TO DENTAL OFFICE/ NEW INTERIOR PLUMBING "'check #15808
Valuation _ $7
Issued By
Deduct Meters
_ Wtr Sewer Mtrs
Wtr Usage Mtrs
Misc. - -_-
Fixtures
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Plan Approval $0.00 Permit Fees _ $56.00 ❑ Permit Voided)
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
Parcel Id #
1311840000
Date 12/21/2011
Agent/Owner
Address 709 W DEERVIEW DR APPLETON WI 54913 - 9677 Telephone Number 920 - 739 -1399
To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Numaer, type or
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.
City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 Q --f H1\'.,JJH ._ . '!_I G' i�IFiT
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 Halt, 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
If you are a contractor participating in the Permit Fee Account Svstem and have adeauate funds. check here
if you want this Processed through your account
** 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 EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion. p
Job Address 9) (p3 W1 V" I f Ve Value (Including labor and materials) y%p �% Q, eD Date
Owner Dr -Th o m a. s #a(luuLst Contractor cerr ( 5 Alttmiin a 2vtr. - '7;k9 0 &k 9
❑Single Family ❑Duplex ' ❑Multi- Family ❑Rental XCommercial ❑Industrial
Number of Fixtures:
Bathtub
Sump Pump
Plaster Sink %
Roof Drain
Shower
San. Sump/Pump
Scullery Sink
Soda Disp
Whirlpool
Water Softener
Service Sink
Coffee Mkr
Lavatory 1
Standpipe Rec
Shamp Sink
Site Drain
Toilet i
Garage FD _
Surgeons Sink
Waitrs Stn
Kit Sink
Local Waste
Sterilizer
Ice Chest
Disposal
Bar Sink
RPZ Valve
Comm lee Maker
Dishwasher
Breakrm Sink _
Bidet
Int Grease Trap
Floor Drain
Classrm Sink _
Urinal
Ext Grease Trap
Hose Bibb i_—
Exam Sink
Beer Tap
Eye Wash Stn
Water Heater
F Prep Sink _
Dipper Well
Deduct Meter
Gas _I Elect _ 1 PwrVnt
Floor Sink
Drink Fran
Wtr Sewer Mtr
Clothes Wshr
Hand Sink _ ��
Wash Fntn
Wtr Usage Mtr
Lndry Tray
Lab Sink
Catch Basin
Misc Fixtures
Electric Contractor (for projects not requiring an EIV Form)
Use / Nature of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
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