HomeMy WebLinkAbout0156192-Plumbing (laterals) �
� CITY OF OSHKOSH No 156192
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3783 GLENSHIRE LN Owner WISCONSIN MHP 6 LLC Create Date 06/14/2013
Contractor ABSOLUTE PLUMBING OF WISCONSIN Category 401 -Residential-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 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 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 MOBILE HOME/Run sewer and water laterals to house.
of Work
""*'*check#2645""
Size Material Type # Conn.Type
Sanitary Sewer 4" Plastic Lateral 1 New
Storm Sewer
Water Service 3/4" Plastic Lateral 1 New
Parcel Id#
1278400000 '
Valuation $500.00 Plan Approval $0.00 Permit Fees $100.00 ❑ Permit Voided I
Issued By TJ�Yt Date 06/14/2013
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 N1473 ELLEN LANE GREENVILLE WI 54942 -9602 Telephone Number 920-757-7222
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 specifed 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 of Oshkosh RECEIVE
lnspection Services Division / -'
P O Box 1130 �� �������C �
�
Oshkosh,WI 54903-1 1 30 �UN 13 20 �
Phone:(920)236-5050
Fax:(920)236-5084 (��i�!�,!`(�r�
l�EPART11E�f SGL
Plumbing Permit Applica�i��sER���sD�a,�v�T�R
I hereby apply for a permit to do and install the fo(lowing plumbing on the premises hereinafter described,the work to conform to the
Wisconsin State Piumbing Code,in the performance of which all patties hereto agree to and are bound by said statutes.
• Applica6on(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 pernut(s)will result in fees being doubled or 5100.00 plus the normal permit fee,which
ever is greater.
OR
�vou are a contractQr a�°ating in the Permit Fee Account Svstem and have adequate funds check here
if vou want this processed through vour account n
**Advisory-For applicable projects,an Electrical Installation Verification(EI�form,signed by the Electrical
Contractor or Homeowner(for installations allowed to be performcd by the homeowner)must be submitted {
with the penmit application. Applications snbmitted without an EIV when snch is reqnired,will not be
pmcessed for Pt�it Issnance and w�l be retarned for completion.
Job Address-�����-����- � Value(�ma�i�no�ona��s� �/� _ Date������'3
,
Ow er (�%/��/Vlni"�/p��� Contractor �f�;��L!%��/�CU/�'l�//f%� l�G�%�cS%��
Single Family ODuplea ❑Multi-Family �Rental ❑Commercial DIndnstrial
Number of Fiatures:
BatMub Sump Pump Plaster Sink Roof D�ain
Shower San.Sump/Pump Scullery Sink Soda Disp
VYhidpool Water Softener Service Sink Coffee Mkr
Lavatory Standpipe Rec Shamp Sink Site Drain
Toilet Gazage FD Surgeom Sink Waitrs Sm
Kit Sink L.ocal Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve � Comm Ice Maker
Dishwasher Brealam Sink Bidet Int Grease Trap
Fioor Drain Classrm Sink Urinal Fxt Grease Trap
Hose Bibb EXam Sink Bcer Tap Eye Wash Sm
Watcr Heater F Prep Sink Dipper Well Deduct Meter
0 Gas❑Elect C7 PwrVnt F►oor Sink Drink Fmn Wtr Sewer Mtr
�o�W� Hand Sink Wash Fnm Wtr Usage Mtr
��Y T�Y Lab Sink Catch Basin Misc Fixtures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature af Work�,X-�����"����/� �C I'Y�GI�G� /����
Size Material Type # Conn.Type
Sanitary Sewer � / �'�
Storm Sewer
Water Service �� �`%���'�
06/09