HomeMy WebLinkAbout0155071 - Plumbing (basement bathroom) eCITY OF OSHKOSH No 155071
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1013 N LARK ST Owner BERNARD L SORENSON SR REV LIVING TRU:Create Date 04/16/2013
Contractor DRUCKS PLUMBING&HEATING CO INC Category 412-Res-Interior(New/Relocated Fixtures) Plan
Inspector Jerry Fabisch
Bathtub 0 Clothes Wshr 0 Classrm Sink 0 Surgeons Sink 0 Roof Drain 0 Deduct Meters 0
Shower 1 Lndry Tray 1 Exam Sink 0 Sterilizer 0 Soda Disp 0 Wtr Sewer Mtrs 0
Whirlpool 0 Sump Pump 1 F Prep Sink 0 RPZ Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 1 San Sump/Pump 0 Flr/Wst Sink 0 Bidet 0 Site Drain 0 Misc. 0
Toilet 1 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. 0 Fixtures
Kit Sink 0 Standp Rec 1 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 Scully 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 SFR/Basement bathroom and laundry space.
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1602410000
Valuation $9,000.00 Plan Approval $0.00 Permit Fees $54.00 ❑ Permit Voided]
Issued By Date 04/16/2013
In the performance o 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 314 APPLETON ST MENASHA WI 54952 -2318 Telephone Number 426-2654
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.
R-16-2013 01:10P FROM:DRUCKS PLUMBING (928)722-0651 70:2365084 P.1
City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh,WT 54903-1130
Phone:(920)236-5050
Fax;(920)236-5084 Oil-KOJI-I
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 Il
**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.
°O Job Address 3 Ai. CO..,-LQ Si-• Value (Includinglaborandmaterials) 40G
Date 4/, ite-13
Owner R e nde.. 5 oreNS a u Contractor 'Of u-c.(cS.
['Single Family ❑Duplex ❑Multi-Family ['Rental
DCommercial ❑Industrial
Number of Fixtures:
Bathtub Sump Pump / Plaster Sink Roof Drain
Shower _i___ San.Sump/Pump Scullery Sink Soda Disp
Whirlpool Water Softener T Service Sink Coffee Mkr
Lavatory _L Standpipe Ree / Shamp Sink Site Drain
Toilet _i_ Garage FD Surgeons Sink Waitrs Stn
Kit Sink Local Waste
Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher Rreaknn Sink Bidet Int Grease Trap
Floor Drain Classnn Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap Eye Wash Stn
Water Heater F Prep Sink Dipper Well Deduct Meter
0 Gas 0 Elect 0 PwrVnt Floor Sink Drink Fntn Wu Sewer Mtr
Clothes Wshr Hand Sink Wash Fntn Wu Usage Mtr
Lndry Tray 11 Lab Sink Catch Basin Misc Fixtures
A 1 sa Vlv4 t-... c i a r•.l �, (24.4-4 r60yi4 Gro v,p.
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
06/09