HomeMy WebLinkAbout0156706-Plumbing (tub spout & drain) � CITY OF OSHKOSH No 156706
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1545 SANDERS ST Owner EARLIN/MILDRED KUSSMANN Create Date 07/15l2013
Contractor REBATH OF CENTRAL WISCONSIN Category 413-Res-Interior(Replacement Fixtures) Plan
Inspector Jon Mueller
Bathtub 1 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 FldWst 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 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 SFR/install tub spout and drain
of Work
"debit acct"
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1305080000
Valuation $200.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I
Issued By ,��- Date 07/15/2013
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 230 N KOELLER ST OSHKOSH WI 54902 -4104 Telephone Number (920)765-0068
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. :
�u1. 15 2013� 2: 08PNw � REBATH CENTRAL WI 9203035935 � � No. 4367�P. 3/3 .
Ytione:(ylU)2'j6-�U�U . . . . . . . . �/ .
Faz:(920j 236-5084: . � . �. � � . lJ � KO H �
� � . ON THE WATER
: .� . . Plumbing Permit Appl.ication �
I hereby apply for�a permit to.do and install the following plutnbing.on the premises hereinafter descnbed;the work to conform io rhe
� Wisconsin State Plumbing Co.de,in the per�onmance of which all parties hereto agree to and are.bound by said statutes_
� • Applieation(s)and fee(sj can be brought.to Cit3�Hall,Room 205 or mailed to l'nspectioA Services,pO,Box 1128,Oshkosh Wlr
54903-1128. CominencinD work without permit{s)will result in fees,bemg doubled or S 100.00�lus the normal permit fee,which
. ever is greater. .
. . OR
I ou are a contraCtor artici utln in the Permit Fee AGCOUnt S ste�n aRd have ade uQ[E unds check here `
i ou wanl lhis rocessed throu h vour account .
**Ad�visory-For applicable projects, an Electrical Xnsi-allatian Ve 't�Sication(EI�form, szgned by the Electri.cal
Contractor or Honaeowner(for iu�stallations allowed to be pe�ozmed bp the homeowner}must be submitted �
with tb�e permit ap�lxcaxion. Applicat3ons snbmitted withont aa ExV when such is required, will not be
pmcessed for Permit Tssuance and wi11 be retamed for campletion. �
�Job Address �5� /��� �
Ir V9jue(1ncluding labor and materials)�(�/'� Dgt� ��-�3
Ownc�- . S�' Contractor � ��j�� (�1�,1�FOY?S � DP�q: �01�A�)
❑Si�ag)e Family ODaplex �Mul�-Fam�y ORental ❑Commercial
� [�lnductrial � ,
Number of Fixturesr
Bathmb � SumP�roP Plas�cr Sink
Roof Dra;n
Showcr Sen.Sump/!'ump Scullery 3ink 5oda Disp .
Wniripooi Wet«SoReaer Service Si�k . Coffiee M(Q
Lavatory S�sndpipe Rcc . Sh�np Sink . . Site Drain
Toilct Gm�e p� � Surgcvns 5ink • Waius Stn �
Kit Sink I.ocal Waste Stcrilizer • Ice Chest
D�� Bar Sink RPZ Valve Comm Icc Maker
Dishwashor Brealam Sink 'Didet Int Grcase Trap
Aloor Draio Classrm S�nk. Urinal Ext Grcase Trnp
Hose Bibb . Exam Smk Beer T�' � Eyo Wash Str�.
.WA�[;p� F Prep'Sia1c Dipper WeII � . llcducl Metex
. •0 Qns❑Elett 0 pwrVm Floor Sink Drink Fntri � Wa Sewer Mtr . .
_..
Clorhes Wshr Fiend Smk � . Wash Fntn,_, _...._... U!!tr[Jsage Mtr..
.._ ._.. . . ..
• .. __....
..... ..LRdry.TraY ..... � I�b.Sinl�__........ _. . . _..__.Catch 13�sin . ....._._..._. . . N1isa F�xhu�s... . .
. .. .. . .. _
Electric Coniracto��(for�rojects.not reqt�iring an EIV Form) � "' � �
.... .
.._...... .... .... . . : ......_..... .�
. - .. . .
�'"�, ,1� .. ...._..
�Jse%Nafure of Work l Y 1\�(�QJ� ��1,� �� �i1t 7c'� � YC_. ..:.. ... ... .. ... . . _ .. . .
Size . Material Type # _ Conn.,Type
Sanitary Sewer � ' .
Storm Sewer. � . '. , .
Water Service
. :. 06/09