HomeMy WebLinkAbout0152293 - Plumbing (storm and water laterals) CITY OF OSHKOSH , SEP12 No 152293•
OSHKOSH PLUMBING G PERMIT - APPLICATION AND RECORDTE
ON THE WATER BERGSTROM PROPERTIES INC Create Date 09/11/2012
Owner 12
Job Address 2201-2281 W WAUKAU AVE Plan _— —
Contractor SCOTT DENOBLE&SONS SEWER&WATER INI Category 445-Commercial-Exterior Other —
Inspector Jerry Fabisch Deduct Meters
Bathtub Clothes Wshr Classrm Sink Surgeons Sink Roof Drain Deduct ct Me ers
Exam Sink Sterilizer Soda Disp Wtr
Shower __Lndry Tray Wtr Usage Mtrs
F Prep Sink RPZ Valve Coffee Maker g
Whirlpool Sump Pump - Site Drain Misc. 4
San Sump/Pump FIrIWst Sink Bidet Misc.
Lavatory — Urinal Wait.St.
Toilet Water Softner Hand Sink
Kit Sink _Standp Rec Lab Sink Beer Tap Ice Chest Comm Ice Maker
_Gar Drain Plaster Sink _ Dip Well
Disposal — Drink Ftn Int Grease Trap
Dishwasher Local Waste Sculry Sink _
Sery Sink Wash Ftn Ext Grease Trap
Floor Drain Bar Sink
Hose Bibb
Breakrm Sink Shamp Sink Catch Basin 6 Eye Wash Statn
Water Heater Manholes
Use/Nature COMM\Storm and water laterals
of Work
L Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer 18"
Plastic Lateral 1 New
Water Service 8" Copper Lateral 1 New
Parcel Id#
1365060000
$0.00 Permit Fees $170.00 ❑ Permit Voided
Valuation $110,000.00 Plan Approval Date 09/11/2012
Issued By ��
In the performance of this work, I agree to perf9fm all work pursuant to rules governing the described construction.s perform the work
While the City of Oshko h has no authority to/enforce easement restrictions of which it is not a r to if you pt the
;10Ct lication within an "asement,the City strongly urges the permit applicant
described in this permi =pp
y� %.a� approvals before starting such activity. �. /, J
�Se easement holder(s)ato s- ur an ,+ Date
i
Signat A `i
Agent/Owner
Address 1910 VERLIN RD GREEN BAY WI 54311 -0000 Telephone Number 920-4 69-2420,920-4
Type of
your Name and Phone
To schedule inspections please call the Inspection Access into Building if Secure(how do we gain entry), Number, yp
Number. (i.e. Footing, d otherwise,Final, etc.),i
Number. Unless specified otherwise,we will assume
business e days from the time the project request
s ready.received. Work may
continue if the inspection is not performed
City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh,WI 54903-1130
Phone: (920)236-5050
Fax: (920)236-5084 OJHKOJH
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 Pt
**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 fot completion.
Job Address (-17,:-A Of ' , kl �J'W WIN'a1>l><e(Including labor and materials) �/ Li Date
Owner k.8 6 ,y /1 e C.-, Contractor p.5 et#De it /'6c ui (15-itslLLcz -
❑Single Family ❑Duplex ❑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 Service Sink Coffee Mkr
Lavatory Standpipe Rec Shamp Sink Site Drain
Toilet Garage FD Surgeons Sink Waitrs Stn
Kit Sink Local Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher Breakrm Sink Bidet Int Grease Trap
Floor Drain Classrm Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap Eye Wash Stn
Water Heater F Prep Sink Dipper Well Deduct Meter
0 Gas 0 Elect 0 PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin IP Misc Fixtures
tY1A0"t 111.
Electric Contractor (for projects not requiring an EIV Form)
Use/Nature of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
a&1 r6'' (5" I01'' in'' PVC
CjIt -,
Water Service o "
06/09