HomeMy WebLinkAbout0155544-Plumbing (laterals) � CITY OF OSHKOSH No �5s544
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 820 JACKSON ST Owner JOSEPH M HILLMER Create Date 05/09/2013
Contractor D.R. HANSEN PLBG. Category 401 -Residential-Exterior(laterals) 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 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 Serv Sink 0 Wash Ftn 0 Eut 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/Installing a new water lateral into house/water calc sheet is required
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service 1" Plastic Lateral 1 New
Parcei Id#
1006290000
Valuation $2,500.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided I
Issued By �� Date 05/09/2013
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 strongiy urges the permit applicant to contact the
easement holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
AgenUOwner
Address 55 KNAPP ST OSHKOSH WI 54902 -3448 Telephone Number 233-1595
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.
c�^,°_s, ''-_-- J1�1 �c:ccr,r �n:Ge��,un sMrr•i.es .na. 4�» �r. �
lnepccriqn 3ervlcas Dlvision � �
P 0 aox 1130 �
Oshkos�,R+Z 54903-1130
Phone:(920)236-5050 �
Faz:(920)236-5084
TEM
� .Plumbing Pernnit Application
I hereby apply�'or a permit tc do and ias;a�i�t�e fo��o�ving pl�a;�bing on the preraE��s heroina'R�r descrihet�,the work�o ccnform to�he
Wlsconsin Statc Ptumbtng Code,in the petformanca of which all psrtlos betet�agee t��end are 6putfd by saidsratutes, :
� Application(s�and fee(m)cgn bt brought to Criy Hall,R,onrn 205 or matled t��speetloa Setvicxe,Pp Box 1 l28,Oshk,�sh A'1
54903-I IZR. Commcn�ing wprk withottt pvtmjt(s)wilt rnxult i�faes belag doubled er S10o.00 plus the normal permh fbe,whlch
�Yar is geattr.
O�t
Tf vnu arr_a �u„r.ac�et nartte�ating ;n rhe p�nrlt xee�ccoxnr Svatcm and have ade4aat�r �xndc e6te� he�N
l�vuu »nn� rt�ia orawe�sed throygh vae�r c�count I�l "
**AQv�sory•For app�icable px�jecta,aa Etectaeal Tastelladon Vc�iflwut�on(EI'i�.fonm,sa�ed br t1e Electrical
Conir,actpr or X�omeow�acr(�QX nnstallatloa�a�!]oaed ro lrc pcd'otmedbT thc hamco�vncr)bnust be antr�+irnd
w�the�ex�n�t applicaaoxt, Appl�Catfivns snbmri:[ted witb�ont an 6�when such Ia t'eqtd�d. w,71 not b�
pr�ccsscd fnr Pexmit Issnaace au,d vr�U b�ret�med�'oz eanwplction.
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F,lrctric Co�ntractor(for projects not reqniring an EIV Formj
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