HomeMy WebLinkAbout0154342 - Plumbing (capping the sewer) CITY OF OSHKOSH No 154342
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 654 FREDERICK ST Owner CITY OF OSHKOSH REDEVELOPMENT AUTHC Create Date 02/05/2013
Contractor TOM VAN HANDEL CORP Category 401 -Residential-Exterior(laterals) 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 0 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/Capping the sewer and water to raze the house. -l
of Work
Size Material Type # Conn.Type
Sanitary Sewer Lateral 1 Aband
Storm Sewer
Water Service Lateral 1 Aband
Parcel Id#
0704440000
Valuation $200.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided
Issued By ��� Date 02/05/2013
In the performance of this work, I agree t• •erform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no autho to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit •• ic- ,n withi 1 n easement,the City strongly urges the permit applicant to contact the
easement holde s) . d to re an 1 cessary -••rovals before starting such activity.
Signature > ' Date
Agent/Owner
Address 1830 E EDGEWOOD DR APPLETON WI 54913 -7757 Telephone Number 920-735-1221
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 Oshkosh
0
Inspection ion Services Division
P O Box 1130
Oshkosh,WI 54903-1130 0 WI c..--
Phone: (920)236-5050 Oc,v-nr-.') O J��O��
Fax: (920)236-5084
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 6`s / f r'JeIt S Walue (Including labor and Date
Owner Cr,�1 �S)1 1 v S l"1 Contractor 1 oh, h ,jr_. Cor`f.,
❑Single Family ['Duplex ❑Multi-Family ['Rental ❑Commercial ❑Industrial
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
F Prep Sink Dipper Well Deduct Meter
❑Gas❑Elect❑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 a� `` 1/3
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
06/09