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Home My WebLink About0155637-Plumbing � CITY OF OSHKOSH No 155637 OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 303 OXFORD AVE Owner ADRIEN H/CARLA M HOLTZMAN Create Date 05/14/2013 Contractor HOMEOWNER Category 412-Res-Interior(New/Reiocated 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 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 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 GreaseTrap 0 Floor Drain 0 Bar Sink _ 0 Serv 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\Adding basement bath of Work Size Material Type # Conn.Type Storm Water — Parcel Id# 0403150000 Valuation $900.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I : Issued By L-Yl�--- Date 05/14/2013 The undersigned,in applying for a plumbing permit to install plumbing in a single family home owned and occupied as the principle residence of the undersigned,hereby acknowledges,per Wisconsin State Statutes,ss 745.06,that other individuals will not be employed to assist with the work described by this permit. If an individual will be employed to install plumbing the work involved must be covered by a permit issued to a prope�lv licensed Master Plumber. In the performance of this work, I agree to perform all work pursuant to rules governing the described construction. Signature �� C � Date �J � I ( AgenUOwner Address 303 OXFORD AVE OSHKOSH WI 54901 4535 Telephone Number (�'a�5'c(��l 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. 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. City of Oshkosh Inspection Services Division � P O Box 1130 � Oshkosh,WI 54903-1 1 30 Phone: (920)236-5050 � F�:�9za,z36-sog4 OlHKO H �� 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 I/'vou are a contractor participatin� in the Permit Fee Account Svstem and have adeguate 1'itnds, check here if vou want this processed throu�h vour account n **Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Electrical Contractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be snbmitted with the permit application. Applications sabmitted without an EIV when such is reqnired,will not be processed for Permit Issnance and will be returned for completion. ` ~lG� Date 5 �`� �� Job Address �� lJ�Fi)r��(^ Va�UC(Including labor and materials) Owner �0.r(Cc �I6I�m Un Contractor Sc%I� �S+�gle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial Number of Fixtures: Bathtub Sump Pump Plaster Sink Roof Drain Shower 1 San.Sump/Pump Scullery Sink Soda Disp Whirlpool Water Softener Service Sink Coffee Mkr L.avatory �_ Standpipe Rec Shamp Sink Site Drain Toilet � Garage FD Surgeons Sink Waitrs Stn Kit Sink L,ocal Waste Sterilizer Ice Chest Disposal Bar Sink RPZ Valve Comm Ice Maker Dishwasher Breakrm Sink Bidet Int Grease Trap Floor Drain Classrm Sink Urinal Ext Grease Trap Hose Bibb Exam Sink Beer Tap Eye Wash Stn Water Heater F Prep Sink Dipper Well Deduct Meter �Gas�Elect G PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr Lndry Tray Lab Sink Catch Basin Misc Fi�ctures Electric Contractor(for projects not requiring an EIV Form) Use/Nature of Work ��,�'�q�L��.hro�,m Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service 06/09