HomeMy WebLinkAbout0156424-Plumbing (water heater) � CITY OF OSHKOSH No 156424
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 926 CEAPE AVE Owner CHARLES D BUTZLAFF Create Date 06l27/2013
Contractor KOCH PLUMBING&HEATING INC Category 411 -Residential-Water Heaters 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
Whiripool 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. � 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
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 1
Use/Nature SFR\PV WH .
of Work '
� .
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
0802330000
Valuation $650.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided�
Issued By Date 06/27/2013
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 2005 DOTY ST OSHKOSH WI 54902 -7040 Telephone Number 920-231-6661 or 235
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.
Ciry of Oshkosh �
Inspection Services Division �
P O Box 1130
Oshkash,WI 54903-1130
Phone: (920) 23fr5050 �/
Fax �92o,236_5�84 of HI���
. n�!TH=�VA7FR �
Plumbing Permit Application
I hereby apply for a per�nit Co do and'mstall the following plumbing on the premises hereinafter desa�ibed,the work to confocm to the
Wiscon.sin State Plumbing Code,in the p�fo�ance of which all parties hereto agree-to arni are baund by said statutes.
• AppIicatlon(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspecfion Services,PO Box l I28,Oshtcosh WI
54903-1128. Commencing work without perntit(s)will result in fees being doubled or 5100.00 plus the normal pernvt fee,which
ever is greater.
aR :
I ou are a contract r ariici atin in the Per►nit Fee �tccount S stem a►rd have ade uate nnds check here
i ou want this rocessed throu h our crccount
� **Advisory-For applicable projects,az!Electdcal Installation Ve�ifira�ion(E1V)fonm,sigaed by the Elec�cal
Contractor or Homeowner(for mstal�axions allowed to be pe�o�med by the homeowner)�st be sobmitted
w�ith the permit a�pZication. Applications sabmitted withont an EIV when snch is reqnired, will not be
processed for Penmit Issua.nce and w�l be retaraed for completion- :
Job Address �1 Z(� �i�o� , r % ��`,i� �d y- ��` ��' "f-.j
`' =' � '�� � � , VBIIIe (Ioduding labor and roaierials) � Date
�
Owner [�</�i�?(.�z5 `;���_-L,�;�r�•� Contractor �15C� �G'�v �
(�Single Fam�7y QDuplea OMulti-Family ORental ❑Commercial DIndostrial
Number of Fixt�eres:
Bathmb Sump Pump Plaster Siolc Roof Drain
Shower 5aa.Sump/Pump 5cullery Siok Soda Disp
WhirIpool Water Softener Se�vice Sink Coffee Miv
Lavatory Standpipe Rec Shamp 5inlc Ske Ihain
ToIIet Gazage FD Surgeoru Sink Waitts Sm
Kit Sink Local Wasie Stailiz� lce Chesc .
Disposat Bar Sink RPZ Valve _ Comm[ce Maker
D'uhwasher BrealQm Sink Bldet Int G�ease Trap
Flaor D�ain Cla�m Sin[c • Urinal Ext Gcease Trdp
Hase Bibb Exi�r►Sink Beer Tap Eye Wash Sm
Water Heat� f F Prep Sink Dipper Well T3educt Meter
�Gas�E]ect�PwrVnt Floor Sink Drink Fnm WU'Sew�Mtr
Clothcs Wshr Hartd Sink Wash Fnm ,�_ Wtr Usage Mtr
i.odry Tny Lab Sink Catch Basin M1sc Fixnues
Elertric Contractnr{for projects not requiring an EIV Form)
Use/Natare�fWork ,pi�:%�f'.;��- ��.��:'-,`<'�:'-, . `;.�:�F_ .f. _ :
Size Material Type # Conn.Type
Sanitary Sewer , � � �
Storm Sewer
Water Secvice
�This instaltation is cornplete and ma�be inspected at any time.
C�� .� 06/09
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