HomeMy WebLinkAbout0157589-Plumbing � CITY OF OSHKOSH No 157589
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 22 W BENT AVE Owner OSHKOSH RENTAL PROPERTIES LLC Create Date 08/07/2013
Contractor KELDERMAN PLUMBING Category 412-Res-Interior(New/Relocated Fixtures) Plan
Inspector Jerry Fabisch
Bathtub 1 Clothes Wshr _ 1 Classrm Sink 0 Surgeons Sink 0 Roof Drain 0 Deduct Meters 0
Shower 1 Lndry Tray 1 Exam Sink 0 Sterilizer 0 Soda Disp 0 Wtr Sewer Mtrs 0
WhiHpool 0 Sump Pump 1 F Prep Sink 0 RPZ Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 1 San Sump/Pump 0 FI�/Wst Sink 0 Bidet 0 Site Drain 0 Misc. p
Toilet 1 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. 0 Fixtures
Kit Sink 1 Standp Rec 0 Lab Sink 0 Beer Tap 0 Ice Chest p
Disposal _ 0 Gar Drain 0 Plaster Sink 0 Dip Well 0 Comm Ice Maker 0
Dishwasher 1 Local Waste
Floor Drain 0 Bar Sink 0 Serv Sink 0 Wash Ftn 0 Ext Grease Trap 0
Hose Bibb 0 Breakrm Sink
Water Heater 0
Use/Nature SFR/ENTIRE HOUSE REMODEL/ interior plumbing associated with the remodel of house/all work shall meet
of Work plumbing code/water calculation sheet needs to be done/attahed is correction notice of all code violations
I '
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1502620000
Valuation $1,500.00 Plan Approval $0.00 Permit Fees $81.00 ❑ Permit Voided I
Issued By ��-- (�, - Date 09/O6/2013
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 easem t,the City strongly urges the permit applicant to contact the
easement holder(s)and to s neces approvals before starting such activity.
Signature Date --�j��
AgenUOwner
Address W5007 AMY AVE SUITE 3 KAUKAUNA WI 54130 -0000 Telephone Number (920)450-5398(cell)
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 Oshkosh .
Inspection Services Division �
P O Box 1130 �
Oshkosh,WI 54903-1130
Phone:(920)236-5050
F�:(920)236-5084 O.IHKOlH
ON THE WATER �
Plumbing Permit Application
I hereby apply for a permit 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 norma)permit fee,which
ever is greater.
OR
If vou are a contractor participating in the Permit Fee Account Svstem and have adeguate fi�nds check here
if vou want this p�•ocessed throu�vour account n
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form,signed by the Electrical
Contractor or Homeowner(for installations allowed to be performed by the homeowner)must be snbmitted
with the permit application. Applications submitted without an EIV when such is reqnired, will not be
processed for Permit Issaance and will e retarned for completion.
�
Job Address Va�UC(Including labor and materials) �� ate
Owner Contractor ✓
�ingle Family ❑Duplex ❑Multi-Family ❑Renta ❑Commercial ❑Industr' ;
Number of Fixtures:
Bathtub � Sump Pump � Plaster Sink Roof Drain
Shower _� San.Sump/Pump Scullery Sink Soda Disp
Whirlpool Water Softener Service Sink Coffee Mkr
Lavatory � Standpipe Rec Shamp Sink Site Drain
Toilet 1 Garage FD Surgeons Sink Waitrs Stn
Kit Sink � L,ocal Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher � Breakrm Sink Bidet Int Grease Trap
Floor Drain Classrm Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap Eye Wash Stn
Water Heater F Prep Sink Dipper Well Deduct Meter
�Gas C�Elect 0 PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr i Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray � Lab Sink Catch Basin Misc Fixtures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
06/09