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Home My WebLink About0153538 - Plumbing (water heater) CITY OF OSHKOSH No 153538 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 10 14 W IRVING AVE Owner THOMAS J BOLLOM Contractor KELDERMAN PLUMBING --- -- --- Create Date 11/13/2012 Category 446-Commercial-Water Heaters Plan Inspector Jerry Fabisch Bathtub Clothes Wshr Classrm Sink Surgeons Sink Roof Drain Shower Lndry Tray Exam Sink Sterilizer — _ Deduct Meters er Soda Disp Sump – -- -- p Wtr Sewer Mtrs Whirlpool P _ Pump F Prep Sink RPZ Valve Coffee Maker Lavatory San Sump/Pump FIr/Wst Sink Itr Usage Mtrs —__ Bidet Misc. 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 Floor Drain ---- Int Grease Trap Bar Sink Sery Sink Wash Ftn Ext Grease Trap Hose Bibb Breakrm Sink Shamp Sink Catch Basin Water Heater 1 --_Eye Wash Statn Use/Nature COMM(14 W IRVING-BAR)/REPLACE ELECTRIC WATER HEATER —of Work i Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Parcel Id# 1004430000 Valuation brI)L,)0 Plan Approval $0.00 Permit Fees j $25.00 ❑ Permit Voided Issued By — — Date 11/13/2012 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 applica io within an easement,the City strongly urges the permit applicant to contact the easement holder(s) .. • se - an •-.(''"-_. - pprovals 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 Inspection Services Division P O Box 1130 Oshkosh,WI 54903-1130 Phone: (920)236-5050 Fax: (920)236-5084 ofHKOJH 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 n **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 /' Value (Including labor and materi s) C Date //7_5?"--/ Owner L�el/, Contractor �'�cyP et') 00/[3�`� ❑Single Family ❑Duplex ❑Multi-Family ❑Rental [Commercial ❑I1idustrial 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 I F Prep Sink Dipper Well Deduct Meter ❑Gas tElect❑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 Size Material Type # Conn. Type Sanitary Sewer Storm Sewer Water Service 06/09