HomeMy WebLinkAbout0152880 - Plumbing (disconection) Aloe
4 1''''' .),id 0# CITY OF OSHKOSH No 152880
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1615 CRYSTAL SPRINGS Owner CITY OF OSHKOSH Create Date 10/10/2012
Contractor CITY OF OSHKOSH Category 401 -Residential-Exterior(laterals) 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 Flr/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 Scully 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/Disconnect water and sewer laterals at the right of way. Disconnection at the main will be in 2013.
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1308870000
Valuation $1,000.00 Plan Approval $0.00 Permit Fees $0.00 ❑ Permit Voided
Issued By kiV"v Date 10/10/2012
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) d to secure any necessary approvals before starting such activity.
Signature -w 2' AC__ Date !( /o�/Z
Agent/Owner
Address 215 CHURCH AVE OSHKOSH WI 54901 -0000 Telephone Number
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.
•
REQUEST FOR EXCEPTION TO REQUIRED
SEWER AND WATER ABANDONMENT REGULATIONS
Date to 00 ft-2_
Address of building ((P(S Cv S ( � 'ny
Name of Owner C(14, e C,54 L3 L
Address of owner at S G-z,-e
The undersigned Master Plumber requests that the requirement for abandonment of the
sewer and water laterals for this address not be required to meet the ordinance for
abandonment at the property line before raze or removal of the served structure. (Check
one or provide Information)
• The utilities will be reused for new construction at this site within twelve months of
the date of request for exception. If the utilities will not be reused within this time
frame they will be properly abandoned at the property line per ordinance
requirements no later than twelve months from date of this request.
• The utilities will be properly abandoned after the structure is removed to make the
futilities accessible for abandonment. The utilities will be secured against damage
during demolition and until they can be abapdoned to meet the requirements of
ordinance. of to exceed 60 days� �� )C ear ( d-c,a 3,
• Other reasons for the requested exception: 46.141ov7(41 e.4 cn
t c�; (1 pa.'t .4- (3 C.,- ,54,42-f) ps.--0J cc/4,
(Continue on the reverse side of form It necessary)
Master Plumber Date
Master Certificate Number
Mailing address
Approved: Date
(Ptumbmg Inspector)