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Home My WebLink About2012-Plumbing (cross connection) CITY OF OSHKOSH No 153727 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 3265 S WASHBURN ST Owner BERGSTROM FOX VALLEY INC Create Date 11/27/2012 Contractor OGDEN PLUMBING Category 442-Commercial-Interior(New/Relocated Fixti 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 1 Coffee Maker Wtr Usage Mtrs Lavatory San Sump/Pump FIr/Wst Sink Bidet Site Drain Misc. 1 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 backflow preventer for beverage dispenser Use/Nature COMM/installing cross connection protection to be in compliance with the correction notice sent from Hydro Designs of Work Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Parcel Id# 1365010000 Valuation $3,400.00 Plan Approval $0.00 Permit Fees $25.00 ❑ Permit Voided Issued By Date 11/27/2012 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 PO BOX 689 NEENAH WI 54957 -0689 Telephone Number 725-8985 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. 11/27/2012 11:35 9207258984 OGDEN PLUMBING PAGE 03/08 City of Oshkosh-Inspection Services Division-Plumbing Permit Application Page 1 of 2 Division of Inspection Services Chi O 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 Fax (920) 236-5084 Phone(920) 236-5050 5—h k051 051 PLUMBING PERMIT APPLICATION All Information with * next to it must be provided. Incomplete applications will not be processed. 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 Mall, 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. If you are a contractor oarQOipr `I the Permit Fee eccou.r Svstem an_d have adeouate funds. tvoe YES i' • - •- • • eased hr_naurlh your acco nt 1 Advisory- For applicable projects, an Electrical Installation Verification (UV) 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. *308 ADDRESS ��'- S i:l�� sf ,139 r *OWNER 84-5 f". 'w'-• *CONTRACTOR: -f Opde& P/6 *VALUE' 3 4/00 4 *USE CATEGORY U Single Family 0 Duplex 0 Multi-Family Rental Commercial 0 Industrial Bathtub Sump Pump Plaster Sink Roof Drain Shower San. • Scullery Soda Disp Sump/Pump Sink • Whirlpool Water Softener Service Sink Coffee Mkr Lavatory Standpipe Rec i Shamp Sink Site Drain Received Time Nov. 27. 2012 11 : 35AM No. 1758 • . _,. ___ ___i.•_.r.-....w:... rlv.al.,.,,,,An1lfncr,P!tir n Services/Permit AUU... 11/27/2012 11/27/2012 11:35 9207258984 OGDEN PLUMBING PAGE 04/08 City of Oshkosh- inspection Services Division- Plumbing Permit Application Page 2 of 2 Toilet Garage FD Surgeons Waitrs Stn Sink Kit Sink Local Waste Sterilizer Ice Chest Comm Ice Disposal Bar Sink , RPZ Valve Maker Int Grease Dishwasher Breakrm Sink Bidet Trap Ext Grease Floor Drain Classrm Sink Urinal Trap . Hose Bibb Exam Sink Beer Tap Eye Wash Stn Water Heater F Prep Sink Dipper Well Deduct Meter Li- i i L.1 Pwr Wtr Sewer Floor Sink Drink Fntn Mtr Gas Electric Vnt Wtr Usage Clothes Wshr Hand Sink Wash Fntn Mtr Lndry Tray Lab Sink Catch Basin Misc Fixtures t� *USE/ NATURE OF WORK r s far 1I N rrt ..� I3, ire w ,9acI -P/ate �-- I R? !/�a f ','- P,'esSca"-� ca s Eo^ ELECTRIC CONTRACTOR (for projects not requiring an EIV Form) Size Material Type # Con 1. Sanitary i , Sewer _.. Storm Sewer I. ... Water Service ; ` Submit Reset Received Time Nov, 27. 2012 11 : 35AM No. 1758 u+i.,•I/W 1r.,r; nchknch wi.»s/Community Dcvelopmcntl Inspection_Services/Permit App... 11/27/2012