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� CITY OF OSHKOSH No 156748 Y
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 233 DALE AVE Owner EUGENE J/HEATHER N KANGAS Create Date 07/17/2013
Contractor ATOMIC PLUMBING Category 411 -Residential-Water Heaters Plan
Inspector Jerry Fabisch
Bathtub 0 Clothes Wshr 0 Classrm Sink 0 Surgeons Sink 0 Roof Drain 0 Deduct Meters 0
Shower 0 Lndry Trey
Whiripool 0 Sump Pump 0 F Prep Sink 0 RPZ Vaive 0 Coffee Maker 0 Wtr Usage Mtrs 0 �
Lavatory 0 San Sump/Pump _ 0 FINWst 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 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 1
Use/Nature SFR\Replace NG WH
of Work
F
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Size Material Type # Conn.Type
Sanitary Sewer
1
Storm Sewer
Water Service f
Parcel Id#
0403780000
Valuation 850. 0 lan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I
Issued By Date 07/17/2013
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the
easement holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
AgenUOwner
Address PO BOX 388 RIPON WI 54971 -0388 Telephone Number (920)748-2075
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
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CI Of�S�1�COS�1 �
I�«�s���o���s��, J U L 17 2 013
P O Box 1130 �
OSf1kOSh,W154903-1130 DEPART;�1E\T OF
Phone:�����6-5�$� INSPE�CI'I(1�SFR 10E.SO I�iSIQ'V ��/(' u
Fax:(920)236-5084 ,f—N�\` (_—I
� C?:T!-!F Y�AiFR
Plumbing Permit Application `
�
I hereby apply for a pemiit to do and install the following plumbing on the premises hereinafter described,the work to conform to the
Wisconsin State Plumbing Code,in the performance of which all parties hereto agree to and are bound by said statutes.
• Application(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 permit(s)will result in fees being doubled or$100.00 plus the normal permit fee,which
ever is greater.
OR
�vou are a contractor participatinQ in the Permit Fee Account Svstem and have adeQUate funds, check here
if vou want this processed through vour account ❑
**Advisory-For applicable projects,an Elec6rical Installafiion Verificatioa(El�form,signed by the Electrical '
Coatractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be snbmitted
with the pernut application. Applications sabmitted withont an EIV when sach is reqnired,will not be
processed for Pemut Issuance and will be retarned for completion.
Job Address �33 �/}�E �1l�• V8IU8(t►xJuding labor and materials)���D•D D Date 7 / /
Owner �-I�A�'N�2 ANGftS Contractor DYl lC �GU/-t�3litl��- t1TC3-• f i��('_
�Single Family []Duplez ❑Multi-Family ORental ❑Commercial ❑Industrial
Number of Fixtures:
Bathtub Sump Pump Plaster Sink Roof Drain
Shower San.Sump/Pump Scullery Sink Soda Disp
Whirlpool Water Softener Servicc Sink Coffee Mkr
L,avatory Standpipe Rec Shamp Sink Site Drain
Toilet Garage FD Surgeons Sink Waitrs Sm
Kit Sink Local Waste 5terilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ia Maker
Dishwasher Breakrtn Sink Bidet tnt Grease Trap
Floor Drain Classrm Sink Urinal Ext Grease Trap
Hose Bibb Exam S�nk Beer Tap Eye Wast►Stn
Water Heater �_ F Prep Sink Dipper Well Deduct Meter
�G�o Elect�PwrVnt Floar Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fnm Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures
Electric Contractor(for projects not requiriag an EIV Form)
Use I Nature of Work l.C1f���� f�����J�. �PG-��°�1��lUT � J��-D� `
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service �
06/09