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Home My WebLink About0154755-Plumbing (toilet) � CITY OF OSHKOSH No 154755 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 716 W 20TH AVE Owner MICHAEL S CLAUSEN Create Date 03/19/2013 Contractor D R GLAZE PLUMBING Category 413-Res-Interior(Replacement Fixtures) Plan Inspector Jon Mueller 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. p 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 Serv 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 FR(RENTAL)/REPLACE TOILET "check#1212 - of Work I� i i i Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Parcel Id# 1408730000 Valuation $360.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I Issued By (�1 C )ll" Date 03/19/2013 In the performance of this work, I agree to perform all work pursuant to rules governing the described construction. While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work described in this permit application within an easement,the City strongly urges the permit applicant to contact the easement holder(s)and to secure any necessary approvals before starting such activity. Signature Date AgenUOwner Address 1865 JAMES RD OSHKOSH WI 54904 -6873 Telephone Number 920-589-4014 To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may continue if the inspection is not performed within two business days from the time the project is ready. City of Oshkosh �� l�� Inspection Services Division �� h`�, P O$ox I 130 f � � 3�� `�� : Oshkosh,WI 54903-I130 / � ,, :�� ,° Phone:(920)236-5050 3l ��l �'Q�� Fax:(920)236-5084 �r �`�i i��{ ' Plumbing Permit Application �f�� _��`��r��' 1 hereby appiy for a petmit to do and install the followintr plumbing on the premises hereinafter described,the work to conform to tllc Wisconsin State Piumbing Code, in the performance of which alt parties hereto agree to and are bound by said statutes. ' App)ication(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services,PO Box 1128,Oshkosh WI 54903-l 128. Commencing work without permit(s)wilt resuft in fees being dovbled or$100.00 pius the normal permit fee,which ever is�reater. OR If�vot� a�•e a contractor narticipatin� in the Permit Fee Account Svstem ancl have adeQUate fttnds eheek hate 1 ou rvant thrs rocessed throu�h vour account I-1 *'�Advisory-For applicable projects, an Eleciricai Installation Verification(EIV)form,signed by the Eleetrical Coniractor or Homeowner{f�r installations allowed to be performed b�the homeowner)must be snbmitted with the permit applieatioa. Applications snbmitted without an EN when such is reqaired, will not be processed for Permit Issaance aad will be returned for completion. Job Address (If� ��„��,r �7g]lle(IncludingJaborand materials) �3�� DatC '� (S 2O Owner /�,eF �Sr.� c � _ Contractor � �c,,4z` � ❑Single Family I?u lez � P ❑Muiti-Famiiy �Rental ❑Commerciat ❑Industrial Number of Fixtures: t�athtutr 5ump Pump Plaster Sink Show�er Sen.Sump/Pump RoofDrain 5cullery Slnk Soda Disp wh��p�ot WAter 5oftener Lavatory Service Sink Coffee Mkr Standpipe Rec Shamp Sink 7 odet Site Drain —�--- Garage FD Surgeons Sink Kit Sink Local Waste Waitrs Sfi Sterilizer [ce Chest Uisposat Sar Sink RPZ Vaive Comm Ice Maker Dishwaeher Bre2krm Sink Bidet Int Grease Trap Floor Drain Classrm Sink Unnaf Eat Grease Trap � Hose Bibb Exam Sink Beer Tap Eye Wash Sm Water Heater F Prep Sink Dipper Weil _.Gas! Elecf:-PwrVnt Deduct Meter Floor 5ink Drink Fntn Clothes Wshr Wtr Sewer Mtr Hand Sink �i�ash Fntn l.ndry 7�ray Lab Sink Wtr Usage Mtr Catch Basin Misc Fixtures �lectric Contraetor(for projeets aot requiring an EIV Form) Use i 1Vature of Work Ep — �, Size Material Type # Conn.Type Sanitary Sewer Sform Sewer Water Service odio�