HomeMy WebLinkAbout0154893-Plumbing (interior) � CITY OF OSHKOSH No 154893
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 15 ALLEN AVE Owner CYPRESS HOMES INC Create Date 03/12/2013
Contractor SBS PLUMBING LLC Category 410-Residential-Interior Plan
Inspector Jerry Fabisch .
Bathtub 1 Clothes Wshr 1 Classrm Sink 0 Surgeons Sink 0 Roof Drain 0 Deduct Meters 0
Shower 1 Lndry Tray 0 Exam Sink 0 Sterilizer 0 Soda Disp 0 Wtr Sewer Mtrs 0
Whirlpool 0 Sump Pump _ 1 F Prep Sink 0 RP2 Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 2 San Sump/Pump 0 FINWst Sink 0 Bidet 0 Site Drain 0 Misc. 0
Toilet 2 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. 0 Fixtures
Kit Sink 1 Standp Rec 2 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 1 Local Waste 0 Sculry Sink 0 Drink Ftn 0 Int Grease Trap 0
Fioor Drain 1 Bar Sink 0 Serv Sink 0 Wash Ftn 0 Ext Grease Trap 0 •
Hose Bibb 2 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 1
Use/Nature NSFR/interior plumbing associated with the new construction of a house
of Work
i
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1516580100
Valuation $6,500.00 Plan Approval $0.00 Permit Fees $144.00 ❑ Permit Voided !
���'
Issued By ..5� '� . 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 4635 RED FOX RD OSHKOSH WI 54904 -7784 Telephone Number 920-410-5933
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Pertnit 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
Phone:(920)236-5050
Fax:(920)236-5084 O I--IKO H
� ON THF WATFR
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 participatinQ in the Permit Fee Account Svstem and have adequatefunds, check here �
if vou want this processed throu�h vour account �
**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 z
with the permit applicarion. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
�o � /
Job Address �� /��� �� VaIUe(Including labor and materials) �r 3�U��� Date � l 7 3
Owner ��s 0� Contractor s�� ���
�Single Fam ly ❑Duplex ❑Multi-Family ❑Rental ❑Commercial �Industrial
Number of Fixtures:
Bathtub / Sump Pump / Plaster Sink Roof Drain
Showcr _L_ San.Sump/Pump Scullcry Sink Soda Disp
Whirlpool Water Softener Service Sink Coffee Mkr
Lavatory Z Standpipe Rec �2- Shamp Sink Site Drain
Toilet Z Garage FD Surgeons Sink Waitrs SM
Kit Sink � Local Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valvc Comm Icc Makcr
Dishwasher ` Breakrm Sink Bidet Int Grease Trap
Floor Drain � Classrm Sink Urinal Ext Grease Trap
Hose Bibb Z Exam Sink Beer Tap Eye Wash Stn
Water Heater ( F Prep Sink Dipper Well Deduct Meter
`Gas !Elect' PwrVnt Floor Sink Drink Fntn ���ED
� � �
Clothes Wshr Hand Sink Wash Fnm Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures
APR 012013
Electric Contractor(for projects not requiring an EIV Form)
CO�1�fiJ�ft�'�EF'ELOP!NENT
Use/Nature of Work �xsr�c�rie,���r��:v3C£S DiFIS10N
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
06/09