HomeMy WebLinkAbout0156050-Plumbing (sump pump) F
� CITY OF OSHKOSH No 156050
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 52 STONEY BEACH RD Owner MARK K/KELLY K LAUX Create Date 06/06/2013
Contractor D R GLAZE 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 1 F Prep Sink 0 RPZ Valve
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. Q 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 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature FR/REPLACE SUMP PUMP **check#1222
of Work
I
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1414510000
Valuation $225 00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided i
Issued By ���- Date 06/06/2013
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 1865 JAMES RD OSHKOSH WI 54904 -6873 Telephone Number 920-589-4014
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.
Cin�oi O:Lkvs} � .
[nspeefion Sen-ices Di�isiofl
P O Box 1130 �
Oshk��h.WI�4997-I1�0 �
Plione:�9?G1.;6-SCiSJ �''� �J
Fax:(9:pj 236-Slbi l 1 f�I\��1�����
._J'--_. ..
Plumbing Permit Application
7 tzn�c ap�1;:�or a permit iQ cio and install tLz fo?lazr�a piui3�bing on thr przeises her�,naffer v�escribe.:.tl.e u�rk to�nfornz m die
!t';�cor.sia Statz Piusb;ag Code.;n th:peNOnna�cr of�.��ich il partie>�ereta a¢re^te acd xre boucdb��saed statutes. �
• nppGcafionfs)avd feq si car be bronght io Cih�HaL=,Rumn�05���ii�ailed to ht;pactiur Sei�ices.�tl Sos]l35.Ochkoc.lt R'I _
5d�h:�3_i l_S.Coimneuciva nor}:a-aLout penuittsl�vill result u�::ee�Ueiia douUled or Slnq.pij plus tLe r;ormal pennit fee,�-1ii:h �
z��er is¢reater. ..
OR �
/�o �.., �,.s����ces ��� .icipsrr t .»_iLe Perrni_r Fcs�ccau Si -Rrn,a�d 1,7ie.. .eg�ure ti�rr+s chec �,,ere
� o��,,. p �,_o� ,�o,�r_u<<o�,,,r_p
*�Adsisot�-Forappiieableprojects,anEfectticallnsW[latioa�'eri6carion(EIVjForm,s�gnedbptheElectrica! � � ��� j
Coutractor or Homeowner(for installalions allowed to be performed bc the Iwmeou�ner)mnst be submitFed �
vcith the permit application. APplicatioen suhmitted without an EN when sucli is reqiured,will not be ��GC�U
processed for Pe�mit Issuanee and will be returned for completion.
Job Address-—�-=��'d�� �'atae([���tioai:�.�a��a;a��_�r��� ^ Date__��S12113 � r/��
-- --- �y. _ { J
Otirner t Contractor � �G�4'� �A��e� !
�nele Famlt� Duptex �liul8-Famliy ORental ❑Commercial QIndastrfal
�umber of Fistures:
3art:�ut ___ �e:mpPavp �_ F:a..r:r5ini: __ ..��Y�rin ___ .
5;.�:.� ....... ia�c��mpR;mF ... .... �-:utla���ini: .. . .. `�dnD:F ....
d�hi�{p._: ...... P�a�aSc.-;ear. ..... ja,,.:�:�cL ........ -.:r.�.\'ia .....
'_a�:Lr:- .._...... S+zndpiP'Dec ......... S:�.mmGSink ........ SueDrys . . . ,
I.ilrt Gs aeFD c�i:-'.,s Sn., ?��io-s�..�
�:��e:: . ..... i.ceeu R-etc ..... 5;-i.i:xer .. _ :�:;lh«r -
....... ...... .. ._....._ . ....... �.
II,.fi»i . ...._ 3ac:��c ...... RPZ'.'ad�:. ....._ CornT::e4Faker ..... �.
D:;Gaa�v.. Br<aVa.^�5;a. ___ 3�yt ....._ intGeas.Tr¢p ......
F��,.rDrn� ........ C�ass�ni�ok ... ... ;�naai ...._... 'ttGreas,Trap ... .
H:.g�� _zma cink -____.. �.a To2 . t,.e;[-o>�em . �.
. i�� . __-._ _'—___'
.im.�Feaze- F PreP S6�k __ TJly�er tr�t ➢zdnelMu.: __
C�as Eln:t F-.rt'o: Flo�r.Si:�i: Dr.ckF��- c`'«S�>'.`n . . . ..
....,. ..... ..
C Icthe�R f r __._. Hm�d 3inl, u'ih Fr.�.n �`.r l'siee\in
^�..r�a; Lab�id: __.. r.i:z5,vvu _._ �lis.fii:ucn .__._ �
£learic Contracror(Cor projecfs not requiring an EI�'Forn�)
L"se/\ature of�Z"ork���ic� �w� i'�-�
_ _._.._. ------ ._ ---- ---- ----- ---- _
S.ze \Sa[er.af T}�ye = Conn T�pe �� �
S:mitar,-ge�v�r �� ,
�[onn Sz-,�er ', _
���ater 4en��.�: �