HomeMy WebLinkAbout0155828-Plumbing (dishwasher) � CITY OF OSHKOSH No 155828
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 95 ROILING GREEN CIRCLE Owner MARIE ELIZABETH RAYOME/DAVID E GILL Create Date 05/28/2013
Contractor RAUSCH PLUMBING Category 413-Res-Interior(Replacement Fixtures) 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. p
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 Piaster Sink 0 Dip Well 0 Comm Ice Maker 0
Dishwasher 1 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 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0 '
Use/Nature FR/REPLACE DISHWASHER •'check#27653 I
of Work
I
i
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
0658420000
Valuation $113.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided
Issued By �'1I I 11 il.J _-- Date 05/28/2013
� �—
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 1606 W HASKEL ST,STE A APPLETON WI 54914 -5032 Telephone Number 920-830-9222
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.
�ECEIVED
City�f Oshkosh �
Inspection Services Division MAY 2 4 2013 �
P O E3ox f 130
Oshkosh,WI 54903-1130
Phone: (920)236-5050 E9EP.a,RTD1E:�T OF OJHKOlH
}���: (y20)236-5084 CO�I�YU\i�'YDE�'ELOPMENT
INSPECTiO�SERViCESDi�"ISION or.i rHF wnTFR
Plumbi�ng Permit Application
I hereby apply for a permit to do and install tl�e 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 Ue Urought to City Hall,Room 205 or mailed to Inspection Services, PO Box 1128, Oshkosh WI
54903-1 128. Co►nmei�cing work without pertnit(s)will result in fees being doubled or$100.00 plus the normal permit fee, wliich
ever is greater.
OR
���u u�e u conh acto��a�ticipatinQ in lhe Pernzit Fee Aceount Svstem and have adequute hrnds eheck l�ere r
ir i�uu ii ant Ihis processed th�•ottgh vott�� accuunt I—I �
** Advisory-For applicaUle projects, an Electrical Installation Verification(EIV) form, signed by the Electrical
Coj�::actor or Homeos�rier(for installations allowed to be performed by the homeowner)must Ue submitted
with the pennit application. Applications submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
Job Address � !�!� n�-Ce VaIUC (Including labor and mate ials) � ! �� Date �3
O
`��ncr l "\ v- - � � Contractor ��i.c.S C�
[�,Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
Number of Fixtures:
I3athtub Sump Pump Plaster Sink P.00f Drain
Sho�cer San.Sump/Pmnp Scullery Sink Soda Disp
\Vhirlpool Water SoRener Service Sink Coffee Mkr
La�at<�rv Standpipe Rec Shamp Sink Site Urain
Toilct Garage FD Surgeons Sink \uaitrs Stn _
t�it Sink Local Waste Sterilizer Ice Chest
f)isposal Bar Sink RPZ Valve Comm Ice Maker
Uish�casher
� Breakrm Sink Bidet Int Grease Trap
Floor Drain
Classrm Sink Urinal iixt Grease Trap
►losc Ribb
Exam Sink Beer Tap F=ye Wash Sm
\Vater I Ie;�ter __
F Prep Sink Dipper Well I`educt Meter __
���(,ns I�Elect U PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Cluthes Wshr Hand Sink Wash Fntn �`1tr Usage Mtr
I.ndrv'frav Lab Sink Catch Basin Ntisc Fixtures
P'�lectric Contractor (for projects not requiring an EIV Form)
Usc / Nature of Work ( l /��SG�wc, �..t✓ �
Size Material Type # Conn. Type
�anitary Sewer
Storm Sewer
Water Service
06/0°