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HomeMy WebLinkAbout0155347 - Plumbing (bath remodel) CITY OF OSHKOSH No 155347 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 808 CEAPE AVE Owner HENDO PROPERTIES LLC Create Date 04/26/2013 Contractor REBATH OF CENTRAL WISCONSIN 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 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 FIr/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 SFR1 Bath remodel-replace fibergalss tub and install 3 pc.surround of Work Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Parcel Id# 0801990000 Valuation $1,000.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided Issued By Date 04/30/2013 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 230 N KOELLER ST OSHKOSH WI 54902 -4104 Telephone Number (920)765-0068 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. SBD-10877(2/2012) CITY HALL 411) Inspection Services Div 215 Church Avenue City of Oshkosh PO Box 1130 Oshkosh WI Of HKOf H 54902-1130 AFF.111)AVIT OF RESPONS II C 11,1 I'Y i, L O v h /v1 M(5(5 ,hereby certify that I am licensed as a Wisconsin Master Plumber, license number 23 II 36 , and that I hereby accept full legal responsibility for the work done by: J©rdkin Sc_,lnm,rI--1- Re % o.F C iy3n \ lid isconso, J orlon �c.,1,,mA-1-J MU* or I in Finn name &address )30 N- ‘<celcr s . , Oshk L, ,,S Owner 5 u oa. I fully understand that this means that I am responsible for providing all necessary and appropriate supervision of this business' plumbing activities including but not limited to notification of inspections per s. SPS 382.21(1)(b)1., Wis. Adm. Code. I will be subject, both ethically and financially, to the life of the plumbing systems installed during the time under the authority of this affidavit related to any plumbing work done by the firm named above. I understand my responsibility starts on the date of signing this affidavit. I will be the responsible master plumber of record for this firm until such date when proper paperwork is filed relinquishing this agreement. .4rift, Master P umber's Signature f ,C- S personally came before me this 1 day of ` Al , 200 . The above named person who executed the 'o going in.' ent and acknowledge ...own 4#t� EYER P '% N the same. / � " iM. Public, S .� of !�consin +'". z a My commission expires 1-3f 1 5 14A �..,...Nr GL)�.t iyi, Wig SBD-10877(2/2012)