HomeMy WebLinkAbout0104232-PlumbingNo 104232
CITY OF OSHKOSH
OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1613 THORNTON DR Owner MICHAEL E/WANDA KERN Create Date 08/19/2003
Contractor HOMEOWNER Category 410- Residential-Interior Plan
Bathtub 0 Shower 0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0 Gar Drain 0
Whirlpool I FloorDrain 0 WaterSoftner 0 DdnkFtn 0 ServSink 0 SodaDisp 0
Lavatory 1 Lndry Tray 0 Local Waste 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
Toilet I Lndry Stndp 0 Clothes Wshr 0 Ice Chest 0 FIr/~Nst Sink 0 Iht GraaseTrap 0
Res. Sink 0 Disposal 0 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
nar Sink 0 Dishwasher 0 Beer Tap 0 SculrySink 0 Wash Ftn 0 RPZValve 0
Water Heater 0 Sump Pump 0 Dent. Oper. 0 Hand Sink 0 Urinal 0 EyeWash Stern 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
~FPJ Finishing off approx. 1/2 of the basement including a Family room and a ~11 bathroom.
Use/Nature
of Work
Storm Water
Valuation $4,000.00
Issued By ~
Size Material Type
# Conn. Type
0
Plan Approval $0.00 Permit Fees
$20.00 [] Permit Voided I
Date 09/17/2003
The undersigned, in applying for a plumbing permit to install plumbing in a single family home owned and occupied as the
principle residence of the undersigned, hereby acknowledges, per Wisconsin State Statutes, ss f45.06, that other individuals
will not be employed to assist with the work described by this permit. If an individual will be employed to install plumbing
the work involved must be covered by a permit issued to a properly licensed Master Plumber.
In the perf,orm~.~.c,~ thais wo~gree t/t~/o~l"EJ~,~r_k pursuant to rules governing the described construction.
Signature~J ~'~/~'J~] ~'~'/' ?~ ~ Date
~ v - - Agent/Owner
Address 1613 THORNTON DR OSHKOSH WI 54904 8294 Telephone Number
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.
While the City of Oshkosh has no authority to enfome 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.
City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
O/HKO/H
ON TH~ 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
normal permit fee, which ever is greater.
OR
lf Fou are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if Fou want this processed through Four account [~
Job Address / ~ / ~ % ~ Y~ ~--,~Value (Including labor and materials~/'/~ ~
Owner m. I~0J ~-9''~''~ Contractor .~D ~rt~, (~{x') YI~"~
~Single Family [--]Duplex [--]Multi-Family [~]Rental [~Commercial [~]Industrial
Date %/7~__~
Number of Fixtures:
Bathtub ~ ~ Lndry Standp Dent. Oper. Shamp Sink
Whirlpool Disposal Dip Well Flr/Wst Sink
Lavatory Dishwasher Drink Fm Catch Basin
Toilet Sump Pump Wait. St. Wash Fm
Res. Sink Ejector/Grind Ice Chest Urinal
Bar Sink Water Softner Exam Sink Gar Drain
Water Heater Local Waste Sculry Sink Soda Disp
[] Gas [] Elect [2 PwrVnt Clothes Wshr Hand Sink Coffee Maker
Shower Bidet F Prep Sink Ice Maker
Floor Drain Beer Tap Serf Sink Site Drain
Lndry Troy Classrm Sink Iht Grease Trap Roof Drain
Lab Sink Surgeons Sink Ext Grease Trap Standp Rec
Plaster Sink Breakrm Sink R.P.Z. Valve Eye Wash Sba
Sterilizer
Electric Contractor
Use / Nature of Work
OR
~]Electric Installation Verification form attached
(If Replacement)
Sanitary Sewer
Storm Sewer
Water Service
Size
Material Type # Conn. Type
7/03