HomeMy WebLinkAbout0156736-Plumbing (laterals) � CITY OF OSHKOSH No 156736
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1411 WHEATFIELD WAY Owner THOMAS R MATCZYNSKI Create Date 07/17/2013
Contractor D.R. HANSEN PLBG. Category 401 -Residential-Exterior(laterals) Plan
Inspector Jerry Fabisch
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. � 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
Fioor 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/installing a storm sewer lateral to house ----I
of Work
i '
�__
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer 6" Plastic Lateral 1 New
Water Service
Parcel Id#
1341050000
Valuation $3,000.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided I,
Issued By .S � � 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
Agent/Owner
Address 55 KNAPP ST OSHKOSH WI 54902 -3448 Telephone Number 233-1595
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 Ushkosh
Inspection Services Diviston
P 0 F3ox 1130 �
Oshkasl�,W)54903-I I30 �
Phone:(920)236-SOSO
Cax:(920)236-SOR4 ��
oN rHE wntEe
Plumbing Permit qpplication
1 liereby apply for a permit to do and install tho following plumbi�g on thc premises herei�aRcr dcscribed,the wo�k to confonn tp the
Wisconsin Scate Plumbing Code, in[he per�ormancc of which all parties hercto agree to and arc bound by said stACUtcs.
• Application(s)and fee(�)can be brought to City�-Iall,Room 205 or mailed to Inspection Servicos,PO•Box I 128,Oshkosh W 1
54903-1128. Commencing work wiihout permit(s)will result in fecs�icing do�blcd or$100.00 plus the normal pormit fce,which
ever is groatcr.
• OR
1 ou are a nlraelor art' i in in lhe Per it ee Account st�►rt and have adeauale �ds. check here
�vou wan[ [�s vrocessed lhroveh your accou�� n
**Advisoary-For applicab�e projects, an��erdnical Installat�irna'Vecificatairnn(E�form,s�igned by the Electrical
Contxactor or I3omeowner(far instaUaiivns allowed to be perfotmed by tl�c homeowner)mnst be snbmitted
wi[th the permit applicafios�. A.pplications sabmitted withonr a�a EIV whcn.sacb�is rc�nixed, will not be
px'ocessed far�e�out Issuance ar.�d w�•bc rctarned far completxoA,, � .
JobAddress ���� �hQwT�i{K�� 3bU D � l7 r
� VRIU@(Tnalud�ng labor and motcrials) D�te�`/�
Owner I(zl�+ti�4� ?�hS M Contractor �l R. Gl. U m�� 7
�Single Fan►ily []baplcx ❑Multi-Family �Rental
❑Com�nercial �Industnixl
Na m bcr of F'txtwes:
Badiwb S��mp Pump Plaatcr$iak
• Itoof Drain
5howcr 5an,3ump/Pump SCUIIcry Sink
Sudn Disp
Wl+irlpuol Walcr Softcnc Scrvicc Sink
Coffcc Mkr
l�vatory Stendpjpc Rcc Shamp 5ink
Sicc Drsin
Toilq Gurnge FT� SurgcMis Sink Wpilrs 5m
KilSink Loca!Wn,etc Stcrilizer
(cc Chcat
Disposel Bor Sink RP"L Velvc Comm Ict Makcr
Dinh�v�ishcr Brc�krtn 5ink SidCl lnl CrrceAe Tr1p �
Floor Drain Clav.wm Sink Urinal F�cf Orcosc Trap �`
Hosc Bihb Exwn Sink Bccr Tap Eyo Waah Stn
Woter Hoacrr F Prep Sink __.._� Dipper Wc11 i.kduG Mcter
I.J Ga L"I EIcc1 Cl PwrVnt Floo�Sink Arink�ntn
W��Scwix Mtr
Clotfics W,hr fipnd Sink Wosh Enu� �. �
Lnd Tr� � W«Usngc Mtr
ry Y �,ab Sink Ca1ah Baain
, Miec Flxcuraa
Electric Contractor(�'or projects not requiring au� EYV k'orm) �
Use/Nature o:f Work n �o r w► �k�Y' '
Si�e Matcrial '1�rpc #, _ Conn_Typc .
Sanitary Sewer
Scorrn Sewer
Wacer Scrvice
06�pe