HomeMy WebLinkAbout0154204 - Plumbing (sump pump) CITY OF OSHKOSH No 154204
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1633 DOEMEL ST Owner WILLIAM J BOLLOM Create Date 01/18/2013
Contractor D R GLAZE PLUMBING Category 413-Res-Interior(Replacement Fixtures) Plan
Inspector Jerry Fabisch
Bathtub 0 Clothes Wshr 0 Classrm Sink 0 Surgeons Sink 0 Roof Drain 0 Deduct Meters 0
Shower 0 Lndry Tray 0 Exam Sink 0 Sterilizer 0 Soda Disp 0 Wtr Sewer Mtrs 0
Whirlpool 0 Sump Pump 1 F Prep Sink 0 RPZ Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 0 San Sump/Pump 0 Flr/Wst Sink 0 Bidet 0 Site Drain 0 Misc. 0
Toilet 0 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. 0 Fixtures
Kit Sink 0 Standp Rec 0 Lab Sink 0 Beer Tap 0 Ice Chest _ 0
Disposal 0 Gar Drain 0 Plaster Sink 0 Dip Well 0 Comm Ice Maker 0
Dishwasher 0 Local Waste 0 Sculry Sink 0 Drink Ftn 0 Int Grease Trap 0
Floor Drain 0 Bar Sink 0 Sery Sink 0 Wash Ftn 0 Ext Grease Trap 0
Hose Bibb 0 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature SFR/REPLACE SUMP PUMP**check#1203 ,
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1514180000
Valuation $2 5.00 Plan Approval _ $0.00 Permit Fees $30.00 ❑ Permit Voided
Issued By Date 01/18/2013
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 1865 JAMES RD OSHKOSH WI 54904 -6873 Telephone Number 920-589-4014
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 y l% l�� S
Inspection Services Division yy w
P s Box 1 130 Iif1 l�
Oshkosh, WI 54903-1130 �—'
Phone: (920)236-5050 C�11 I<C1H
Fax: (920)236-5084
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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 El •**Advisory-For applicable projects, an Electrical I*_::_.:"..' ,
Contractor or Homeowner(for installations allowed to be performed by , - ' ' '
with the permit application. Applications submitted without an EIV when such is required, will not be
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}� 01/4,a_-„,-- Date (,hall
Job Address l -2 l ci_T,i Sr Value{Including labor and material)
Owner "o_ a v Contractor D 'R. C chzc- Rs ti,03c.
Single Family (Duplex (Multi-Family nRental I (Commercial ❑Industrial
Number of Fixtures:
Sump Pump Bathtub
Sum Pum I 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
Break Sink Bidet Int Grease Trap
Classrm Sink Urinal Ext Grease Trap
Floor Drain Eye Wash Stn
Hose Bibb Exam Sink Beer Tap Deduct Meter
Water Heater F Prep Sink Dipper Well Wtr Sewer Mtr
Gas' Elect' PwrVnt Floor Sink Drink Fntn
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 .Cj'...tc� .5.4.0 Ptw.,P -
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
06/09