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Home My WebLink About0155073 - Plumbing (install lateral) CITY OF OSHKOSH No 155073 _ @ OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 2017 JACKSON ST Owner FAMILY DOLLAR STORES OF WISCONSIN INC Create Date 04/17/2013 Contractor BAUMGART PLUMBING Category 444-Commercial-Exterior Laterals Plan Inspector 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 0 Water Heater 0 Use/Nature COMM/Install laterals for Family Dollar Store. A separate right-of-way permit will be obtained. of Work Size Material Type # Conn.Type Sanitary Sewer 4" Plastic Lateral 1 New Storm Sewer 18" Plastic Lateral 1 New Water Service 1" Copper Lateral 1 New Parcel Id# 1219090100 Valuation $15,000.00 PApproval $0.00 Permit Fees $150.00 ❑ Permit Voided Issued By A"'".. Date 04/17/2013 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 e. ,-ment,the City strongly urges the permit applicant to contact the easement holder d to e any . I ry approvals before starting such activity. Signature 2� li 0 Date /— /7- / Agent/Owner Address N5209 HWY 55 SEYMOUR WI 54165 -8115 Telephone Number 920-788-9983 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 Phone:(920)236-5050 OlHKOf H Fax:(920)236-5084 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 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 fl **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 Permitt Issuance and will be returned for completion. Job Address (79-17/9 ,)Cll2�jD4 5 Value(Including labor and materials) j5d�D // Date 9-1'7-192013 Owner 1;di,/1 Pd/l/a!' Contractor / GG r-r /4 1 ['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 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 El Gas Elect=PwrVnt 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 1/y Storm Sewer /" 12x6 I�z. SpA 3 s Water Service " £aff�s- L //l . // 06/09 /5( 62636 / 13� ls- -it