HomeMy WebLinkAbout2012-Plumbing (vacuum breakers) en CITY OF OSHKOSH No 153729
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3245 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 Coffee Maker Wtr Usage Mtrs
Lavatory San Sump/Pump Flr/Wst Sink Bidet Site Drain Misc. 2
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 Vaccum breakers
Use/Nature COMM/installing vacuum breakers for cross connection protection and repiping non-potable water to soap dispenser
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1365010000
Valuation $1,926.00 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 07/08
City of Oshkosh - Inspection Services Division- Plumbing Permit Application Page 1. of 2
4245'37
Division of Inspection Services
f., !. 215 Church Avenue
_v 1� 7` ' P.O. Box 1130
Oshkosh, WI 54903-1130
I t Fax (920) 236-5084
f_ Phone (920) 236-5050
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 Hall, Room 205 or mailed to Inspection Services, PO Box
1.128, 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.
• 1 • . r - 'I • 1 •I' • . I _ l . I - % ;.'_ ' • -
funds. type YES ' • = �•.. • -
** 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.
-
:3 . qS' S Lea s/. b u,'ti
*JOB ADDRESS
*OWNER /t..) S 1-1r.chf i
*CONTRACTOR `J / c e ,t, r !J /
*VALUE:cr/gal&
*USE CATEGORY
o Single Family 0 Duplex 0 Multi-Family 0 Rental 7)Commercial 0 Industrial
Bathtub • Sump Pump Plaster Sink Roof Drain
San. Scullery Soda Disp
Shower Sump/Pump Sink
Whirlpool Water Softener Service Sink Coffee Mkr
Lavatory Standpipe Rec • Shamp Sink Site Drain
Received Time Nov. 27. 2012 11 : 35AM No. 1758
/.,n,..s. „ci,Icncl, ,ui „c/Community Developrnentii nspection._Services/Penmit_App... 11/27/2012
11/27/2012 11:35 9207258984 OGDEN PLUMBING PAGE 08/08
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
RPZ Valve Comm Ice
Disposal Bar Sink 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
[f 0 Pwr Wtr Sewer
Floor Sink Drink Fntn
Gas Electric Vnt Mtr
Wtr Usage
Clothes Wshr Hand Sink Wash Fntn Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures 3
*USE / NATURE OF WORK,,Ale›se �
- —NS-6el/ v- _ /use f3' .L ( xCG S6.eriqk�e. ctrl
• 0 71 e. u 6e. C lot) .F.,(` 6 500,A. fr ,/,� 41e �o s G �
ask gay ,>ti iV
`« .emsse.f . C/,C nx.h �. b / f/ aIt4"�. •
�, mod- � S
ELECTRIC CONTRACTOR (for projects not requiring an EIV Form)
Size Material Type # Con 1.
•
Sanitary
Sewer
Storm
Sewer
Water •
Service
Submit 1 Reset
Received Time Nov. 27. 2012 11 : 35AVI No. 1756
t.++.,.//41,,‘,‘„r.i nehl(nch wi iis/Ccimmunity Development/Inspection._Services/Pezmit App... 11/27/2012