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� CITY OF OSHKOSH No 156284
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Owner EVERGREEN MANOR INC Create Date 06/19/2013
Contractor J RASMUSSEN PLUMBING INC Category 410-Residential-Interior Plan
Inspector Jon Mueller
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 RP2 Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 1 San Sump/Pump 0 FldWst Sink 0 Bidet 0 Site D�ain 0 Misc. p
Toilet 0 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. � Fixtures
Kit Sink 1 Standp Rec 0 Lab Sink 0 Beer Tap 0 Ice Chest 0
Disposal 1 Gar Drain 0 Plaster Sink 0 Dip Well 0 Comm Ice Maker 0
Dishwasher 1 Local Waste 0 Sculry Sink 0 Drink Ftn 0 Int Grease Trap 0
Fioor Drain 0 Bar Sink 0 Serv Sink 0 Wash Ftn 0 6ct Grease Trap 0
Hose Bibb 0 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature MULTI FAMILY/Plumbing to remodel MS 1036
of Work
"'*debit acct'***
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1608640000
Valuation $4,000.00 Plan Approval $0.00 Permit Fees $45.00 ❑ Permit Voided i
Issued By ?t�y� Date 06/19/2013
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 1914 GREENBRIAR TRL OSHKOSH WI 54904 -8887 Telephone Number (920)233-6747(worM
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.
Wentz, Sandra
From: PLUMBING PERMIT APPLICATION [Permit_App_Plumbing@ci.oshkosh.wi.us]
Sent: Tuesday, June 18, 2013 8:28 PM
To: Inspections, Inspections
Subject: PLUMBING Permit Application
PLUMBING PERMIT APPLICATION
Date:6/18/2013 8:27:33 PM
Permit Fee Account System: YES
Job Address: 1130 N Westfield---apt. MS1036
Owner: Evergreen
Contractor: J. Rasmussen Plg Inc
Use Category: Multi-Family '
FIXTURES
Bathtub: Sump Pump: Plaster Roof
Sink: Drain:
Shower: 1 San. Scullery Soda
Sump/Pump: Sink: Disp:
Whirlpool• water Service Coffee
' Softener: Sink: Mkr:
Lavatory: 1 Standpipe Shamp Site
Rec: Sink: Drain:
Toilet: Garage FD: Surgeons Waitrs
Sink: Stn:
Kit Sink: 1 Local Waste: Sterilizer: Ice Chest:
Comm
Disposal: 1 Bar Sink: �l�e; Ice
Maker:
Breakrm Int
Dishwasher: 1 Sink• Bidet: Grease ,
' Trap:
Floor Classrm Ext
Drain: Sink: Urinal: Grease
Trap:
Hose Bibb: Exam Sink: Beer Eye Wash
Tap: Stn:
Water F Prep Sink: Dipper Deduct
Heater: Well: Meter:
i
f
Drink wtr
Floor Sink: Fntn: Sewer
Mtr:
Clothes Wash �'�'tr
Wshr: Hand Sink: Fntn: Usage
Mtr:
Lndry Catch Misc
Tray: Lab Sink: Basin: Fixtures:
*USE/NATURE OF WORK remodel apt MS 1036
*VALUE 4000
ELECTRIC CONTRACTOR
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
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