HomeMy WebLinkAbout0155621-Plumbing (bathtub) � CITY OF OSHKOSH No 155621
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1040 W 19TH AVE _ Owner ERIC W/ANGELA M HENSLIN Create Date 05/14/2013
Contractor KOCH PLUMBING&HEATING INC Category 413-Res-Interior(Replacement Fixtures) Plan
Inspector Jerry Fabisch
Bathtub 1 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 FIHWst Sink 0 Bidet 0 Site Drain 0 Misc. p
Toilet 0 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. � Fixtures
Kit Sink 0 Standp Rec 0 Lab Sink 0 Beer Tap 0 Ice Chest p
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
Hose Bibb 0 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature FR/REPLACE SHOWER WITH BATHTUB **debit acct
of Work
I
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1311560000
Valuation $1,500. Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I
Issued By Date 05/14l2013
In the perFormance of this work, I agree to perForm all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party,if you perform the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the
easement holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 2005 DOTY ST OSHKOSH WI 54902 -7040 Telephone Number 920-231-6661 or 235
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of :
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready. :
City of Oshkosh
Ir�ection Services Division �
P O Box 1130
Oshkosh,V1lI 54903-1130
Phone: (920) 236-5050
Faac (920) 236-5084 O f yKOJ}-..i
. � ' - O:\i HS I�ATFR -
Piumbing Pertnit Application
I hereby apply for a permit to do and install the fol�owing plumbing on the premises hereinafter desaibed.the work to conForm to the
Wisconsin State Plumbing Code,in the performance of which aIl pa�ties hereto agree-to and are b�und by said stacutes.
• Application(s)and fee(s)can be brought to City Hall,Room 205 ormailed to Inspection Secvices.PO Box 1128.Oshkosh WI
54903-1128_ Comrnenc�g work without permit(s)will result in fees being doubled or$i00.00 plus the narmal perm�t fee,which
ever 9s greater.
OR '
I�vou are a coatractor nartici�oatiirg in the Permit Fee Accouat Svstem Qnd have adeguate funds check here
if vou want this processed throuQh your account �
*'"Advisotg-For applicable projects,aa FJectrical Installation Verification(EIV}fomi,sigaed bp the ElecOoical
Conlractor or Homeowner(for�Dations allowed to be perfomied bg the homeowner)asast be sabmitted
with the pemut application. Applications sabmiited withont an FI�when such is reqused,wiIl not be
processed for Penmit Issaance and w�l be retaraed for completion.
Job Address�G�G �'/j�f ��/i�1 Yatue (T���d�ng��T�aa�c«��� /`�SDI� `�-- Date S=/3-ZU/,3
Owner ,�'/�<( h�l%YS�!// Contractor ��'lf/ /�f/�� . �
(�Single Family �Duplez OMeilti Family ORental ❑Commercial �]Industrial
Number of Figtares:
Bathtub � Sump Pu¢np Piaster Sink Roof D_ain
Shovver San.Surop/Pump ScnIIery Sink Soda Disp
WFurlpool Water Softener Service Sink Coffee Miv
I.avatory Standpipe Rec Shamp Sin[c Site Drain
Toilet Gazage FD Suigeons 5ink Waitrs Sm
IC9t Sink Loml Waste Stailizer Ice ChESt
Disposal Baz Slnk RPZ Valve Comm[ce Maker
Distnn,ashcr Breakan Si+wk B(det Int Gxe�se Trap
FJoor Drain Cla�m Sin[c � Urinal F�ct Grease Trap
Hose Bibb Exam Stnk Beer Tap Eye Wash Stn
Water Heater F Prep Sink Dipper WeU Deduct Meter
C Gas❑Elect�PwrVnt F1oor Sink Diink Fnm Wtr Se�uer MV
Clothes Wshr Hand Sink Wash Fnm Wtr Usage M�
�Y TmY Lab Sink Catch Basin � Miu E'ixtures
Elec4ric Contractor(for projects not requiring an EIV Form)
Use/Natare of Work �F`�d���c� S/�/L ii-�J'j� j�1,�TlfJ"L�/�
Size Material Type # Conn.Type
Sa3►itary Sewer r � �
SEorm Sewer
V1/ater Service
❑This installa#�on is complete and may be i�spected at any time,
06/09
6'd Z8Z09£ZOZ6 yoo�{s�ueae�� �6Z�06 £6 £l� {