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Home My WebLink About0154895-Plumbing (interior) � CITY OF OSHKOSH No 154895 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 2017 JACKSON ST Owner FAMILY DOLLAR STORES OF WISCONSIN INC Create Date 03/22/2013 Contractor VALENTINE READER PLUMBING INC Category 442-Commercial-Interior(New/Relocated Fixt� 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 2 San Sump/Pump 0 FINWst Sink 0 Bidet 0 Site Drain 0 Misc. p Toilet 2 Water Softner 0 Hand Sink 0 Urinal 0 Wait.Sk � 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 1 Int Grease Trap 0 Floor Drain 1 Bar Sink 0 Serv Sink 1 Wash Ftn 0 Ext Grease Trap 0 Hose Bibb 1 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0 Water Heater 1 Use/Nature omm/New Store'Family Dollar. **check#1077 of Work I I Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Parcel Id# 1219090100 Valuation $8,775.0 Plan Approval $0.00 Permit Fees $81.00 ❑ Permit Voided Issued By CJ i 1 I t� Date 04/01/2013 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 W 2015 INDUSTRIAL DRIVE KAUKANA WI 54130 -7517 Telephone Number 920-788-2494 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 APR 012013 � P O Box 1130 � Oshkosh,WI 54903-1130 Phone:(920)236-5050 ��'°" �q`�"�� O HKO H Fax.(920)236-5084 C0�11tU19?� ��''F�.OpJfEVT ANSP�C'Pi�� .`iF_'�`e"�''=S DI�ISIOV ON THE�VATFR 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 vou are a contractor participaling in the Permit Fee Account System and have adequate funds, check here �vou iaant this processed throu�your account n **Advisory-For applicable projects, an Electrical Installation Verification(EI�form,signed by the Electrical Contractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be snbmitted with the permit application. Applications snbmitted withont an EIV when snch is reqnired, will not be processed for Permit Issaance and will be retarned for completion. ?' � Job Address�ul � �,J L �Vd�UC(Including labor a d materials)��°� Date 1 ' �"' � �' Owner ��e�«✓ ��v`C�Contractor V�� hL ❑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 Whidpool 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 E�ct Grease Trap Hose Bibb � Exam Sink Beer Tap Eye Wash Stn Water H ater � F Prep Sink Dipper Well Deduct Meter =Gas�Elect °PwTVnt 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 Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water S ice � �/� �� Qx a =8� 06,09