HomeMy WebLinkAbout0155668-Plumbing (laterals) � CITY OF OSHKOSH No 155668
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1016 MERRITTAVE Owner MONIKA WITTLIFF Create Date 05/16/2013
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 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 Serv Sink 0 Wash Ftn 0 Ext Grease Trap 0
Hose Bibb 0 BreakRn Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature SFR/exterior plumbing relaying sanitary sewer lateral per correction notice
of Work
Size Material Type # Conn.Type
Sanitary Sewer 6" Plastic Lateral 1 Relay
Storm Sewer
Water Service
Parcei Id#
1103350000
Valuation $2,600.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided I
Issued By .�-�� ��- Date 05/16/2013
In the perFormance of this work, I agree to perform all work pursuant to rules goveming 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
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 wili 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�RU¢: i�__i�n►� I:i�r�vl ins[ttiian s�rvices .N�. 4:)�, I
tnep�ctlon Scr.vlccs Divtsian '
P 0 Box 1130 � '
Oshkos6,VrZ54903-t130 �
Phorte:(920)236-SOSO �
Fax:(920)236-3084
. nrtk '
. Plumbing Permit Appl�cation
i ha�eby apply for a p�mit tc do end fnsall�c follo�ring plunbing on thc prem�ses hereinatta�deacrit�crl,the work to cenform to rhe
Wis�onsin 5tatc Plumbing Code�in the petfortnancc of which ell percies hecem agee to�encl are bound by saidseau,rtes,
� Application(s1 and fee(s)can bc breugtit to City Ha11,Room 205 or malled t�Lnspacttoa Services,PO Sox 1128,Oshkoch Wl
54903-I 12�, Commce�ing work�vttltont pem:ic(s)wi!(rosul�i�fees being double6 a�5100.00 pluB dte rlot�xiA1 pettltlt fbo,which :
ever is�anter,
OR
!f vo�c�n�rct tor particlnsttln in Ihs p� r�l xe� ,d ou�t,�pe e�n and ho_ve cdeqaate fv�da._ch�� ke�e
1}�vvv wanl /h��„eroceesed tl rough y„oa�es�e,unt rl '
*�Advfsory•For�ppl�cable p�tojcrta,a,�Etectriral Installadmn Verf�ra�ioa($I�.fo�m,si�aod by t3�e�lectrical
Co�ntractc�r or Y�omaowncr(for�anstalIat�ana a[towed ro be pex�ormalbTt�e ho��ow�ecr)mnst be satm+itxed :
w�th tha permic app�icsdoa, Ap�i�eutjona submfitted witb�oat aa�xYwhe�n snc6 ta teq�uced,w71 nptbe
�rocessed far Pexmit?se�auce and wl�i be x�tturned�'or co�mplet�ion, �
Job Addreas �_(����� �r� �IllQ Valae�r��na���ors,a m.,�rt�� � (7 .cSa �� S /6 ��
, � �� c, .
a�ne� r, � N�� Cont�actor ,
[�,Singlc 1�'am.�ly (�Du�l�x Q.Muld-Family ❑ltcntal �Corttmercfsl duntri�l
Number oiFixtures; �
9.Wrub Atsycm� urink r1n
.� ._ �Easirt
wn�oi n�anw�.,n:�► �_ w�R q�. ^, w��„ �� �
LeM�ery Samp PumD ice Chesc `....... Lhiml _.."�
Tolla FJcetntN?inC
"cxsm Sft�k _—. Ci�r,Ureia
Rcs 5tr►k Wn!a 5oflna 5cof 9�ak � ,
7' -r. 9�d�dLap
AarSfnk Locn!Welt: hpad Sinh CuffeeMslrer
� Wetor Me�tx Cbthcs Vl'�I+� F Rep$Ink Caom.ke Maka
�:Cao�6lea'��t'NTMm 9�da
..�..r, San Sink Si1e praio
Shorwt --�—
&a Tap lnt Ctt�e 1'rnp „ W�uf Dnin
F1oorDrnm Ctaasnn Sink 6xl C�a�se Tnq� _.._. , q�„�P�
. �"d�7'I7ay _._,�.. Sn�OS 51AIc
LA6 Sfnk ' RP2.valve �re W�91n
BreoWm Slnk 5aamp Slrtk "� Wtr Sairer Mhs
Pluter Stnk � ���
Ftr�'W�Slok f�educt Mcuas
Slerihxcr Ffose B�x
M�_ � wtr t�o M�
Fi.wYS �
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F.Trctric Contmctor(for pro'ects not reqt,�ring an EIV Form)
Use/Nstnre of 1�%ork C
• S1u Mei�rla) Typ� # Cu�nn.7ype
sanlr�ey Saw�
� I -
; Smtm Sewcr
iWaDer Servfce �
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