HomeMy WebLinkAbout0154609 - Plumbing (replace bathroom fixture0 CITY OF OSHKOSH No 154609
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3730 GLENSHIRE LN Owner LARRY WHEELER Create Date 03/04/2013
Contractor OWNER Category 412-Res-Interior(New/Relocated Fixtures) Plan
Inspector Jerry Fabisch
Bathtub 1 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 1 San Sump/Pump 0 FIr/Wst Sink 0 Bidet 0 Site Drain 0 Misc. 0
Toilet 1 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 RES/Replacing bathroom fixtures. No structural alterations.
of Work
I
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
Valuation $500.00- Approval _______ $0.00 Permit Fees $30.00 ❑ Permit Voided
Issued By ^ Date 03/04/2013
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 held r(s)and to secure an necessary approvals before starting such activity.
Signature (, N\ 1_j� = Date , Li .../3
Agent/Owner
Address 3730 GLENSHIRE LN OSHKOSH WI 54904 -8513 Telephone Number Edison Estates
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
Inspection Services Division
P O Box 1130
Oshkosh,WI 54903-1130
4--)14
Phone: (920)236-5050
Fax:(920)236-5084 OJHKOJH
Plumbing Permit Application ON THE WATER
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 ETV when such is required, will not be
processed for Permit Issuance and will be returned for completion. / ��>>
Job Address 3 73b�l�`n` "1ac's � Value (Including labor and materials) �ap, GV Date 3-- - l
Owner I )v■ek U i\e Contractor
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 L 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 i PwrVnt Floor Sink
Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink
Lndry Tray � Wash Fntn Wtr Usage Mtr
D y Lab Sink Catch Basin
Misc Fixtures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
06/09