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Home My WebLink About2012-Plumbing (Bathroom remodel) a) CITY OF OSHKOSH No 152105 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 1415 RUSH AVE Owner JOHN C SANDBERG Contractor KELLY INSPECTION SERVICE LLC Create Date 09/04/2012 Category 413-Res-Interior(Replacement Fixtures) Plan Inspector Jerry Fabisch Bathtub 1 Clothes Wshr Classrm Sink Surgeons Sink Roof Drain Deduct Meters Shower Lndry Tray Exam Sink Sterilizer Whirl ool Soda Disp Wtr Sewer Mtrs P Sump Pump F Prep Sink RPZ Valve Coffee Maker Wtr Usage Mtrs Lavatory 1 San Sump/Pump Flr/Wst Sink Bidet Site Drain Misc. Toilet 1 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 P 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 Use/Nature ISFR/BATHROOM REMODEL **deibt acct of Work Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Parcel Id# 1609510000 Valuation $3,500.00 Plan Approval $0.00 Permit Fees $25.00 ❑ Permit Voided Issued By CJ Date 09/04/2012 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 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. City of Oshkosh Inspection Services Division O Box 1130 Oshkosh, WI 54903-1130 #14 Phone: (920)236-5050 Fax: (920)236-5084 OJHKO/H Plumbing Permit Application ON THE U/gTER 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 I ou are a contractor •artici•atinf in the Permit Fee Account S stem and have ade•uate unds check here i ou want this processed throu.h our account Ej **Advisory-For applicable projects, an Electrical Installation Verification(EIV)form, signeby the Electr Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted cal 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. Job Address 1 ti/-3 /2LJ. / Value(Including labor and materials) 5-7 d Date '�—/2 Owner Contractor /`w � - /�ngle Family .Du lex ❑Multi-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 T Service Sink Coffee Mkr Lavatory Standpipe Rec Shamp Sink Site Drain Toilet Garage FD Surgeons Sink Waitrs Stn Kit Sink Local Waste Disposal Sterilizer Ice Chest Bar Sink RPZ Valve Dishwasher Breakrm Sink Comm Ice Maker Bidet Int Grease Trap Floor Drain Classrm Sink Urinal Hose Bibb Exam Sink Ext Grease Trap Beer Tap Eye Wash Stn Water Heater F Prep Sink ❑Gas Elect PwrVnt Dipper Well Deduct Meter Floor Sink Drink Fntn Clothes Wshr Wtr Sewer Mtr Hand Sink Wash Fntn Lndry Tray Wtr Usage Mtr Lab Sink Catch Basin Misc Fixtures Electric Contractor(for projects not requiring an EIV 7oT r Use/Nature of Work / es 4-� ��tr�� FA,-�ci2 4S c C "--14-)ve_ Size Material Type # Conn. Type Sanitary Sewer Storm Sewer Water Service 06/09