HomeMy WebLinkAbout0151326 - Plumbing (install back water valve0 CITY OF OSHKOSH No 151326
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 422 STANLEY AVE Owner MICHAEL G/KAREN J DAVIS Create Date 07/19/2012
Contractor HANSON QUALITY PLUMBING Category 410-Residential-Interior Plan
Inspector Jerry Fabisch
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 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 Sent Sink Wash Ftn Ext Grease Trap
Hose Bibb Breakrm Sink Shamp Sink Catch Basin Eye Wash Statn
Water Heater BACK WATER VALVE
Use/Nature SFR/installing a backwater valve to sanitary sewer drain
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1209520000
Valuation $1,500.00 Plan Approval ____ $0.00 Permit Fees $25.00 [I Permit Voided
Issued By Date 07/23/2012
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 550 N BLUEMOUND RD APPLETON WI 54914 -5748 Telephone Number 730-0205
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.
City of Oshkosh
0
Inspection Services Division
PO Box 1130
Oshkosh,WI 54903-1130
Phone: (920) 50
O J l��O��
Fax: (920)236-5084 6-5084
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
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if you want this processed through your account f
Job Address l �� CJ J�`7 1 Value(Including labor and materials) L59 Date 1 -19-)2—
Owner N, 1 k Pkl/I S Contractor fin I1 S (Q,w 4 P I
[Single Family DDuplex DMu1ti-Family ['Rental ❑Commercial DIndustrial
Number of Fixtures:
Bathtub Disposal Drink Ftn Catch Basin
Whirlpool Dishwasher Wait.St. Wash Ftn
Lavatory Sump Pump Ice Chest Urinal
Toilet Ejector/Grind Exam Sink Gar Drain
Res.Sink Water Softner Sculry Sink Soda Disp
Bar Sink Local Waste Hand Sink Coffee Maker
Water Heater Clothes Wshr F Prep Sink Comm.Ice Maker
❑Gas 0 Elect❑PwrVnt Bidet Sery Sink Site Drain
Shower Beer Tap Int Grease Trap Roof Drain
Floor Drain Classrm Sink Ext Grease Trap Standp Rec
Lndry Tray Surgeons Sink R.P.Z.Valve Eye Wash Stn
Lab Sink Breakrm Sink Shamp Sink Wtr Sewer Mtrs
Plaster Sink Dip Well Flr/Wst Sink Deduct Meters
Sterilizer Hose Bibs Wtr Usage Mtrs
Misc.
Fixtures
Electric Contractor OR DElectric Installation Verification form attached
(If Replacement)
Use/Nature of Work kikAtC61 ViCr f t tj&i
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
u/os