HomeMy WebLinkAbout0155923-Plumbing (laterals) � CITY OF OSHKOSH No 155923
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 206-212 ALGOMA BLVD Owner REG DOMESTIC ABUSE SERVICE INC Create Date 06/03/2013
Contractor D.R. HANSEN PLBG. Category 444-Commercial-Exterior Laterals Plan
Inspector Jon Mueller
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. 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
Disposai 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 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature �6"storm drain connection for downspouts.
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer 6" Plastic Lateral 1 New
Water Service
Parcel Id#
0701280000
Valuation $6,000.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided'I
Issued By �� Date 06/03/2013
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
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, Pertnit 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.
au�. l: 2�Di �2:2�F�1 in�Gestion s.rvi:E9 .M� 4 ��r. �
Ci., .. __:.----
lnspectL�n Scrvicts Divi,sion �
P�Box 1130
Oshko�h,R�'�34403-1130
Phone:(9�0)236-SOSD
Fax:(92�)Z36-3084
7 nfEk
.Plumbing Perirtit Application
I hereby apply for e p�rtit te do end'm.,**.all�e folf��ving plumbing on th�ptemis�s heeeinat�descn�+ccl,rhe work co conform m the
Wisconsin Su,tc Plumbing Cod��i�the perfurmance of wh;eh all pareks 6aeto agtee t�end arc bound 1ty ssid smdues.
• Application(s)and feels)c�be breughtto Ciry Hall,Roorn 205 or rr�iled m Inspeuion Servixs,Pp Box 1 IZB,Oshkosh Wl
54903•1[2&. Commcnciag work without Fa-tr:tc(s)vrill�e�,vult�h fees being doubled o�Sl Q0.00 plus�norma.l pettuh Pee,which
eve;is greeter.
OR :
!f ybu gr,y.��p„�r�etor nortie�na,�jJ�g_i rh� Per�lt xGe ccounr S .e�rnr a�f J,ave adequ�t�a �umds. t_ •�lyek kera
1f yvu wan� /lt�¢pJ„Q�BS,rsd lhz4ttgh yQVr cccount rl
**Advisorp•For applieable pxvjeets,a�,�Etecaaeal Fa�talladon�Terificadum(EIYf fonm,si�ned br t3�e�latrical
Contractvr or l�omeowner(fnr nnstatlatw�ns atlowed[o bc perfarnacdbT the ha�meoweer)naust be auba+ittcd
w�th the perrnic appucation. �gpi�catSons submiaed witb�ant am F1Y when snch 1s rcqerucd,will not be
�rocessed f�P�naie Is ce and wtll x d for eompae�tron.
Jab Addreas �� G alne �a� �eor �a �G 0 U� ,V� Datc � 3
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Uwner r 'h �L�1 ContractOr
❑Single 1�'amily [,�Dupl�c ❑�Multi-Family []Rantal �Commerci�l []Ias! �[
Numbe�r of Fl�ctures:
B+�tkn�b Dispoae= I7r�Nc Ftn ,^ Cw.�hEas�n �_
�1�hT�poo1 I1a�wesh:r ,,,,,,r_ N�a1t,SC �,._... Wneh Fm _ ,_
Lev�mry SampPump iaCha�t _.r Urinal ,
TOlkr E,�ecta►lCi;fad "cxsm�idc ^,._ Cmr Droin ,
Rcs.S(nK Wa?tT 5oltruT ScId�Y Siok �..� Soda Dc�a ,��
Bu31nK Loqu Was� _ H�nd Sink Cunr,eMoknr
WaPet Heata Crothr.�tkshr c Prop�in1c Camm 1eeM�lca
:!CaA_I Elect'::PwCYnt B�
ScM1 Sink _„_ Sile D�1ip
sn�
���v i�a���T� _� �,r�„
Floor D�am C'�sm Siak :
6!tf G�dse 1� .._, . CtrM1p Reo
�'O�r°y - 9ur$e�s SJok RP.2.vn1.� ,,, qre►NezA Sw
tab 5iek gro��g� 5�lamy SStk Wa Sawer M�ss
p�S� ' �:'v�ell FtrlWst Sfpk Gedua Me�ex
Sltnli2er - Ha+e Ba,�.+ Wer ll�e Mns
MieC. "".—
6i.etu:es _.r,_,
�iectric Coptractar(for pro'etts t reqn�ting�n EIV Far�pu)
.
Use 1 Natarc of Vi�ork r d /'�'VI ►''C,
� Size Melerla! Typc # Conn.Typc
IS�nhaey 5ewer
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' S�rm Sevrer
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