HomeMy WebLinkAbout0153917-PLBG(ADA Bathroom) City ct Oshkosh
Inspection Services Division
P 0 Box 1130
Oshkosh,WI 54903-1130 4
Phone:(920)236-5050
Fax:(920)236-5084 CO/HKCLH
pN VW;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 arc bound by said statutes.
• Application(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services,p0 Box 1128,Oshkosh WI
54903-1128_ Commencing work without permit(s)will result in fees being doubled or$100.00 plus the normal permit fce,which
ever is greater.
OR
U •u ,re a contractor •arti i•ati t in the Permit Fee Accou t _ cm and have adequate funds. check here,
Lau want this processed throu_J yQur account n
**Advisory-For applicable projects, an Electrical Installation Verification(ElV)form,signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
with the permit application. Applications submitted without an EIV when such is required,will not be
processed for Permit Issuance and will be returned for completion.
Job Address„1501 D I dL Value(Including labor mid materials) 6 SOO•O° Date laljept 1
Owner Contractor 'PTA. 1-1.1(1e1 'Pluednin L.LC
❑Single Family ODuplex [JMulti-Family ['Rental O/Commercial Industrial
Number of Fixtures:
Bathtub Sump Pump Plaster Sink Roof Dram
Shower San.Sump/Pump Scullery Sink _ Soda Disp
Whirlpool Water Softener Service Sink Coffcc Mkt
Lavatory _i____$ Standpipe Rea Shrimp Sink Sitc Drain
Toilet Garage FD Surgeons Sink Waits Stn
Kit Sink Local Waste Sterilizer Icc Chest
. Disposal Bar Sink RP7 Valve Comm Ice Maker
Dishwasher Breakrm Sink Bidet Int Grease Trap
Floor Drain � Classrm Sink Urinal F,xt Grosse Trap
Hnsc Bihb Exam Sink Bar Tap Eyc Wash Stn
Water Heater F Prep Sink Dipper Well Deduct Meter
IJ Gas Ll Elect LI PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Rand Sink Wash Fntn : Wtr Usage Ma
Lndry Tray Lab Sink Catch Basin Misc Fixtures
40 (11ovE. 1-a f
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work
Size Material Type fi. _ Conn_Type
Sanitary Sewer
Storm Sewer
Water Service
06/09
Received Time Dec. 10. 2012 1 : 26PM No. 1887