HomeMy WebLinkAbout0157091-Plumbing (repair sanitary sewer lateral) � CITY OF OSHKOSH No 157091
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 206-212 ALGOMA BLVD Owner CHRISTINE ANN DOMESTIC ABUSE SERVICE� Create Date 08/05/2013
Contractor D.R.HANSEN PLBG. Category 444-Commercial-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 p
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 Breakrtn Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature COMM/repair sanitary sewer lateral
of Work
�"debit acct**
Size Material Type # Conn.Type
Sanitary Sewer 6" Iron Lateral 1 Repaii
Storm Sewer
Water Service
Parcel Id#
0701280000
Valuation $1,000.00 Plan Approval $0.00 Pertnit Fees $50.00 ❑ Permit Voided I
Issued By '�Vy� Date OS/07/2013
In the performance of this work, I agree to perform all work pursuant to ru�es governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party,if you perform the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the
easement holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 55 KNAPP ST OSHKOSH WI 54902 -3448 Telephone Number 233-1595
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
Ciry of Oshkosh
lnspcction Servic.�s Division
P O l�ox !130 �
Oshkosh,WI S49q3-I 130 �
Phonc:(920)236-SO50
Fex:(920)236-5084 � �O �
Piumbing Permit qpplication �N T��`W�'�R
] hcreby apply for a permit to do and instxll thc fbllowing plumbing on the prcmises hereinaftcr describcd,the work to conform Co the
W��consin State Plumbing Code, in the perfiorman�e of which all partics hereto A�rcc to end arc bound by said statutes.
• Applieation(s)and�'ee(s)can be brought to City Hall,Room 205 or mailed to lnspcction Secviccs,PO-$ox 1 128,Oshkosh WT
54903-1128. Commeneing work without permit(s)wi��result in fees bcing doubled or 5100.00 plus the notmal permit fcc,which
cvcr is greater,
OR
�ou are a on[rac[ r wrlici nt' in [he pe►'»iil Fee Afcount S,y,,F1em and huvs adepuale fund
� � anl rhf roce.c. lhrou Q�� �check he;�•e
**Advisory-Fo�r applicablc�nrojects, ar�Electrica��qstaIlatiozt�rerifica4on(EI�foxm,s�igiued by t�e Flectr,ical
Contractrnr or Hom,eownrr(£o��,y��o��owed to be pe�onmcd by the hoat�eowncr)mnst be snbmitted
with t�c Qc�noait appUicatyion. A�plications sabmittcd wiithoat an.EIV whe�a such is reqaired, will not be
processed for Pe�puit Issnan�ce and w7kbe retnrnt�d for com.pletion.
Job Addresa VS�Ue(Including laborand mn exinls) (Y ��
�Aate
��"�� �t ,� h � Contractot �
❑Siugle�'amily []Dup►ea ❑1VI��Iti..Famw�
Y QRcntal []Commcrcial dustrial
Numbe�r of Fixtures:
��t� Sump Pump Pla,ater Slnk :
Showcr ' Roof Drnin �
Smi.Sump/POmp 5cullery Slnk Soda Disp �
WhirlFonl Wnlcr Softcna Savicc Sink
���o Coflcc Mkr
�' - Slandpipe Rec 5homp Sink
Toila C��g�� Sitc Dni�
Surpcons Sink WAitrs Sln
Kit 5ink ►,ocal Wastc
Stcrili�,er Icc Chcst
• nisposel Dor Sink RPZ Velvc
Comm Icc MAkcr
Dishwoshcr Brcnkrm Sink 9idd
1nt Gren.c Trap
Flppr bratn Ctqssrtn 5ink Urinal
I Iosc Bihh Exem Sink ���c Ttap
Flccr Tep F,.yc Waah Stn
Wnter Nester F Prep Sink bipper Wcll
L'J Gart f',I F,�eot fl P►vrVnl �d�cl Mctrr
Fltwr Sink Drink Fi1ln
Cl�hce Wphr Hand Sink Wtr�wa'Mtr
�dry�,�Y ' . Waah En6n •. Wtr Usagc Mtr
�h Sink Ce�ch I9nsin - :
Miiac�ixtur�a
�lectric Contractor(�or ojects not r 'ng EIV Form)
Use/Nature of Work l
S�� Matcrial Type #_ _ Conn.Typc -
Senitary 5cwer :
Storm 5ewcr
Wa[cr Servicc
06/09