HomeMy WebLinkAbout0157571-Plumbing (sump pump) � CITY OF OSHKOSH No 157571
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 305 FULTON AVE Owner ROBERT E SIMMONDS Create Date 09/05/2013
Contractor D R GLAZE PLUMBING Category 412-Res-Interior(New/Relocated Fixtures) 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 1 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. 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 B�eakrm Sink 0 Shamp Sink 0 Catch Basi� 0 Eye Wash Statn 0
Water Heater 0
Use/Nature SFR/installing a sump pump
of Work
I
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1000250000
Valuation $1,600.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I
Issued By ��_ — Date 09/05/2013
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 ' in an easement,the City strongly urges the permit applicant to contact the
easement a to cu necessary approvals before starting such activity.
Signatu e Date �'
AgenUOwner
Address 1 65 JAMES RD OSHKOSH WI 54904 -6873 Telephone Number 920-589-4014
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.
City of OshkosL �� �� /Z.;�.
Iuspectiou Sen•ices Dn-isiou �� � �
P O Box 1130 ��� �
Oshkodi,t'�'I 5-1903-1130
� Plione: (930)236-5050 ������
Fax: (920)23G-508-G � �( �
i �i�
ON THF W/1TFR
Plumbing Permit Application
I hereby appty for a penuit to do vid iustall die follo�vin,plumbius on the premises hereui�fter described,the��-ork to coi�forui to the
Z�'iscousiu State Phuubiu,Code,iu tlie peifoiYU:uice of��i�icli all p<uties hereto a,i•ee to<uid�u•e bot►ud by said st�h�tes.
• Applic�tiou(s)vid fee(s)c�i be brot��t to City Hall,Rooui 205 or ivailed to Iuspectiou Seiz-ices,PO Box 1123,Oslil:os��VI
Sd903-1133. Couuuenciu,��'ot�:«ritlioat pe�uiit(s)�sril!i•esalt ui fees Ueiu,doubled or�100.00 plus die uotuial pe��tuit fee,�vl�ich
e�-er is sa•eater.
` �R
If vou are a contractor,aarticipating tn the Permtt Fee Accounl Svstem and have adequate funds check here
if vou want this processed through vour account n
**Advisory-For appGcable projecks, an Elect�ical Installation Verification(EI�form, s�igned by the Electrical
Contractar ar Homeowner(for installations allowed to be petformed by the homeowner)must be submitted
with the permit applicatian. Applications submitted withaut an EIV when such is required,will not be
processed for Pemut Issuance and will be ret�umed far completion.
3�- � � �
.Job address (.��.�1�/ Ife `'alU@(Inciuding labor andmatenals� ��l/� Date Q r�E�/
Owner b St.,�..,�,�, S Contractor ���rl,.�{zC' G`�s
[►��ii�le Famih ❑Duplea �Dlulti-Famil� ❑Re�ital ❑C'oinmercial ❑Ill(IIIStI'lAl
Number of Fiatures:
Bathtub Sump Pump ' Plaster Sink Roof Drain
Shower San.SumplPump Scullery Sink SodaDisp
Whirlpool Water SoRener Service Sink Coffee Mkr
Lavatory Standpipe Rec Shamp Sink Site Drain
Toilet Garage FD Surgeons Sink Waztrs Stn
Rit Sink Local Waste 5terilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher Breakrm Sink Bidet Int Grease Trap
Floor Drain Classrm Sink Unnal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap Eye Wash Stn
WaterFieater F Prep Sink Dipper Well DeductMeter
Gas Elect PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray Lab Sink Catch Basin Misc Fixtures
Electric Contr�ctor (for projects not requiring an EI�'Form)
Use/Nature of"'ork ��Q.�� s�,,,��� �-Au",r
Size I�I�eri�l T}•pe Conu.T}'pe
Switu}'Se�t-er
Stomi Se�vei•
��'ater Se»-ice
06/09