HomeMy WebLinkAbout2013- Plumbing (eywash stations) CITY OF OSHKOSH No 154825
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1800 S KOELLER ST Owner MIDWEST HERITAGE INN OF OSHKOSH Create Date 03/25/2013
Contractor OGDEN PLUMBING Category 442-Commercial-Interior(New/Relocated Fixti 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 2
Water Heater 0
Use/Nature COMM/installing eyewash stations in two locations -
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1307440108
Valuation $5,000.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided
Issued By � -"--, Date 03/25/2013
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 PO BOX 689 NEENAH WI 54957 -0689 Telephone Number 725-8985
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.
Electric Contractor(for projects not requiring an EIV Form) Pore.
Use/Nature of Work ___ 5 D,-g } q ._ k� s w d,- j k .- C 4C t...(,251
03/22/2013 11:16 9207258984 OGDEN PLUMBING PAGE 01/01
City of Oshkosh
Inspection Services Division
P 0 Box 1130
Oshkosh,WI 54903-1130 (?1*)
Phone:(920)236-5050
Fax:(920)236-5084 OJHKO H_
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
/f you are a contractor participating in the Permit Fce_ziccount Sv.rtem and have adequate funds, check here
if ou want this processed through your accyunr
"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 /few . I koeIIe.- &( Value(including labor and materials) cO"/ ) Date 3-22 43
Owner Fc//` C id 1 i°1 Contractor Ci /... �1;9
[]Single Family EDuplex ['Multi-Family []Rea Commercial Ind
Q ❑ ust,ial
Number of Fixtures:
Bathtub Sump Pump Plaster Sink Roof Drain
Shower San.Sump/Purrtp Scullery Sink Soda D
Whirlpool Water Softener Service Sink Coffee Mkt
Lavatory Standpipe Rea Shamp Sink Site Drain Dra
Toilet Garage FD Surgeons Sink Wants Stn
Kit Sink Local Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm ace Maker
Dishwasher Break=Sink Bidet ant Grease Trap
Floor Drain Classrm Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap Eye Wash Stu __2,__
Water Heater F Prep Sink Dipper Well Deduct Meter
0 Gass 0 Elect 0 PwrVnt Floor Sink Drink Erato Wtr Sewer Mir
Clothes Wain- Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures
Electric Contractor(for projects not requiring an EIV Form) ti
it/o/ ,
Use/Nature of Work Rvhnf-5 •Di^ct• i" Wog 7'c+- •P cr r- 14~0 ties 4'C LVIS16 4j
Site Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Received Time Mara 22. 2013 11 : 16AM No. 2593
06/09