HomeMy WebLinkAbout156852 Plumbing � CITY OF OSHKOSH No 156852
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 2460 SHORE PRESERVE DR Owner ANDREW R/LAUREN A CLAYTON Create Date 07/23/2013
Contractor HOMEOWNER 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 1 Lndry Tray 0 Exam Sink 0 Sterilizer 0 Soda Disp 0 Wtr Sewer Mtrs 0
Whirlpool 0 Sump Pump 0 F Prep Sink 0 RP2 Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 1 San SumplPump 0 FIr/Wst Sink 0 Bidet 0 Site Drain 0 Misc. 0
Toilet 1 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 GreaseTrap 0
Floor 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 SFR1 Completing basment living area. Framing done by Schmidt Bros.-floor plan previously approved-plans on file
of Work
�i
Size Material Type # Conn.Type
Storm Water
Parcel Id#
1281030000
Valuation $1,000.0o Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I
Issued By �C,���""> Date 07/23/2013
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 145.06,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 performanc of this work, I gree to erform all work pursuant to rules governing the described construction.
Signature (. Date�—��^
� AgenUOwner
��-O C��
Address 2460 SHORE PRESERVE DR OSHKOSH WI 54904 7790 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 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.
I �
06/09
City of Oshkosh
Inspection Services Division �
P O Box 1130 �
Oshkosh,WI 54903-1130
Phone: (920)236-5050
Fax:(920)236-5084 ���--�K���
ON THE WATER
Plumbing Permit Application
I hereby apply for a peimit 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 brouaht to Ciry 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
If vou are a contractor participaling in the Permit Fee .Account Svstem and have adequate ft�»ds, check here
f vou want ihis processed throu�h 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 snbmitted without an EIV when such is required, will not be
processed for Permit Issuance and will be returned for completion. �
Job Address� / (.Jl�l v�� 1 � ��Q'�-+��VaIUC(lncluding labor and materials) ( ��� ��� Date �� ���
O ner ��'1Q.�,�+ �� e��^"1�Contractor ��1�--��-
�ingle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
Number of Fixtures:
Sump Pump Plaster Sink Roof Drain
Shower � San.Sump/Pump Scullery Sink Soda Disp
Whirlpool Water Softener Service Sink Coffee Mkr
Lavatory 7� Standpipe Rec Shamp Sink Site Drain
Toilet �_ Garage FD Surgeons Sink Waitrs Stn
Kit Sink Local Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher Breakrm Sink Bidet Int Grease Trap
Floor Drain Classrnt Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap Eye Wash Stn
Water Heater F Prep Sink Dipper Well Deduct Meter
-1 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 Fi�rtures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work ����5�� �'U�/l�� !�- �V�C-I'V�
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
06/09