HomeMy WebLinkAbout0156037-Plumbing � CITY OF OSHKOSH No 156037
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1865 CRESTVIEW DR Owner MR/MRS MICHAEL K SMITH Create Date 06/05/2013
Contractor APPLE CREEK PLUMBING LLC Category 412-Res-Interior(New/Relocated 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 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
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 SFR/interior plumbing changing a tub to a shower
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1315980000
Valuation $1,600.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I
Issued By �Tv!/( Date 06/06/2013
In the performance of this work, I agree to perform ail 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
AgenbOwner
Address 805 E APPLE CREEK RD APPLETON WI 54913 -8368 Telephone Number 920-731-7733
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.
Ciry of Oshkosh
Inspection Services Division �
P O Box1130 �
Oshkosh,WI 54903-1130
Phone: (92Q)236-5050
Fax: (920)236-5084 � ZS•� O HKO �--i
ON TWF�VP,TFR _
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
If vou are a contractor participating in the Permit Fee Account Svstem and have adequate funds, check here
�vou want this processed through your account ❑
**Advisory-For applicable projects, an Electrical Installation Verificadon(EIV)form, signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
with the permit applicadon. Applicadons submitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion.
Job Address 1�t�� C('�5��'47 �r� ViIIUC(Including labor and materials) ��(� BO DiitC - —/ —/
Owner Ih:ke s M��� Contractor ¢.� �v��-��
�ingle Family ODuplex ❑Multi-Family ❑Rental ❑Commercial ❑ dustrial
Number of Fixtures:
Bath[ub Sump Pump Plaster Sink Roof Drain
Shower � San.Sump�'Pump Scullery Sink Soda Disp
Whirlpool Water Softener Service Sink Coffee Mkr
Lavatory Standpipe Rec Shamp Sink Site Drain
Toilet Garage FD Surgeons Sink Waitrs Stn
Kit Sink Local Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher Breakrm Sink Bidet Int Grease Trap
Floor Drain Classnn Sink Urinal Ext Grease Trap
Hose Bibb Exatn Sink Beer Tap Eye Wash Stn
Water Heater F Prep Sink Dipper Well Deduct Meter
'J Gas Ll Elect IJ PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work s�,".��c,� -�-u�,�j +a � �J ��„r�
Size Material Type # Conn. T}'pe
Sanitary Sewer �
Storm Sewer
Water Service
06�09