HomeMy WebLinkAbout0156121-Plumbing (laterals) 1
� CITY OF OSHKOSH No 156121
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1223 MICHIGAN ST Owner ROY M/BARBARA D GABRIELSON Create Date 06/11/2013
Contractor D.R. HANSEN PLBG. Category 430-Industrial-Exterior(Laterals) 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
Whirlpoot 0 Sump Pump 0 F Prep Sink _ 0 RPZ Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 0 San Sump/Pump 0 FIrIWst Sink 0 Bidet 0 Site Drain 0 Misc. 0
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 Scuiry 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\Install new storm lateral "*debit acct
of Work
I
II
i
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer 6" Plastic Lateral 1 New
Water Service
Parcel Id#
1301590000
Valuation $1,000.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided :
Issued By Date 06/12/2013
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, 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.
City o�OshkoAh
Zncpection Services Division �
POBox1130 �
Oshkosh,V1�54903-1130
Phonc:(9Z0)236-SOSO
Fax:(920)236-5084 Q '
oN raE wnr�a
Plumbing Permit A,pplication
T hereby apply for a permit to do and install thc following plumbiog on the premi.ges hereiaaftcr dcscnbcd,thc work to conforat to the
W�sconsin State Plumbing Code,in the per6ormance of which all partios hereto agcee t+o and t�'e bounQ by said s�tute,c_
• Ayplicsc�ion(s)and xoe(s)can be brought to Citp Hall,Room ZOS or mailed to Inspcction Serviccs,PO Box 112R,Oshkosh'WX
54903-1]28. Commencing work without parnit(s)will result tn fees being doubled or$100.00 plus the normal permit fee,which
ever is grcater.
OR
lf vy��e a qo�traclnr a�nalinP in lhe P¢r�i1 Fe .cco n Svstctn��i,.,(�gk,�„g,�g_g�e�,,,�g f�n�,��eeJE here
if vou want tbi.s nrocessed thro�trh vQrrr acco [ rl
**Advisory-For applicable projcccs,an Elec�ical Install�tion v'erificxbiaia(�ZV}fonon,s3�eed by t�e EXed�rical
Cvntractor or Hameowner(for installatxons allowed to be pe�r�o�nated by tbte�tot�neowinea�)�mnst be sn'bna�ited
wi�.the�ex�anat aXrpl�icataiom. A,�licat�ions snbm�tt�ed w�itho�et an EIV wl�cn secb is r.c�nic�ea,w,�nat bc
p�roce�sscd�mr�e�onuit�ssaaace a�rl wx'1�be xet�a�»ed�or cc�m�l�tio,n. � ,
.Tob Addres,c -�a-����C�� f►� Value(T�i�mg ie�mr�na maca;a�q� �0 U C��OU ;pate '� I/ �/
Uwner Contractor C ►0 L.(�,�,,
❑Si�a�le k'a�oniily [�Aaplca� []�a�i-k'aiaaikq ��teni�l ❑Co�nnc�cial dastrial
Number of Fixtures: ,
Ba�htub Sump Pump Ptastcr$ink Roof Uruln
Shoa� 9an.Sinnp/Pump 5cullcry Sink Sodn DiSD
Whirlpool Walcr SaRcnet Semco Smk Co1Tx Mkr
[nvCitory Stendpipe Itcc Shamp Sink Sitc f)rain
Tpilot (itrrllRC TD Surgcona S'vilt P/aitr�$tn
K�f SMk Lowl Waetc Sccrilizc (cC Cltcst
. Di�► Bnr Sink RPZ vnlvc Comm ke Makcr
Dinhwmqher Brcllcrm Sink Didct lrtt Grcavc'Ilgp
p��pn�n C{assrm Sink Urinal ��y��'�p
Hmtc Ribh E�GUn 3mk Aar Ts� Cye Wash 3tr�
�►ffiv Haucr F Pn�f Sirtk .,....,,,_,,. Di�v Wdl Dcduct Mdcr
G Ciao C]Glect fl PwrVnt Flboc Sink ihink F� Wtr Scwcr Mtr
ci«�w�,� y.,,�s� � . VJa9h F.e� •. Wlr U�nge Mtr
Lndry TraY Ial�Siok CaO�h Basin . Mi�c Focturai
Elcctric Contracto�(for pro,jecls not requirin�an ��Y�'orm)
Use/Nuture of Work I �5�'� ( w� �C 1
V�
Sizc Material Typc #� _ Conn.Type _'
Ss�nit�try Scwcr
Stoem Sewer
Wat�r Service
06/09