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Home My WebLink About0152360 - Plumbing (addn to #151405) CITY OF OSHKOSH No 152360 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 206 W SMITH AVE Owner MAURICIO A/STEPHANIE L PEREIRA DA SILVA Create Date 09/05/2012 Contractor KELDERMAN PLUMBING Category 412-Res-Interior(New/Relocated Fixtures) 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 1 San Sump/Pump FIr/Wst Sink Bidet Site Drain Misc. 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 Use/Nature SFR/additional fixture added to permit#151405 **check#2047 of Work ' Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Parcel Id# 1518470000 Valuation $500.00 Plan Approval $0.00 Permit Fees $7.00 ❑ Permit Voided] Issued By � Date 09/14/2012 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 N9679 STATE PARK RD STE 112 APPLETON WI 54915 -9504 Telephone Number (920)450-5398(cell) 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 #C111111.11frilD1114 Inspection Services Division P O Box 1 130 Oshkosh, WI 54903-1130 Phone:(920)236-5050 Fax:(920)236-5084 LDJH\O I 1 Plumbing Permit Application ON WAIFS 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 ri **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. Job Address ( 0(6, L4} So--ti t � Ave - Value(Including labor and materials / A, CV Date 9-/0-/0-- j Owner 5"l`f' V , 5 tpium i e PAP;,,4 04. Contractor Inc irlev vict 0 pI.wl6s,t7e 1-1-(— 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 Addd Lavatory _I Shamp Rec Coffee in amp 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 lnt 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 Gas Elect PwrVnt Floor Sink Drink Fntn 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 4d0/EtA I La Lji k ± Fc J c(+ ft) fr,ia ( -}L1 Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service 06/09