HomeMy WebLinkAbout0157292-Plumbing (laterals) /�'� CITY OF OSHKOSH No 157292
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 929 MERRITT AVE Owner ARLINE D WUSSOW Create Date 08/19/2013
Contractor FREUND EXCAVATING Category 401 -Residential-E�enor(laterals) Plan
Inspector
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 FINWst 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
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 Eut Grease Trap 0
Hose Bibb 0 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature SFR/sewer replacement per correction notice
of Work
Size Material Type # Conn.Type
Sanitary Sewer 4" Plastic Lateral 1 Relay
Storm Sewer
Water Service
Parcel Id#
1100660000
Valuation $2,500.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided�
Issued By �-� Date 08/19/2013
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this ermit applicatio ithin an sement,the C' strongly urges the permit applicant to contact the
easement holde )and to sg,cure y n ary approvals fore starting such activity.
Signature , Date ��/ '/�
AgenUOwner
Address 3135 DELHI RD OMRO WI 54963 -9724 Telephone Number 920-685-2196
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Inspection Services Division �
P O Box 1130 �
Oshkosh,WI 54903-1130
Phone:(920)236-5050
Fa�c:(920)236-5084 OlHKO.IH
ON THE WATER
Plumbing Permit Application
I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described,the work to conform to the
Wisconsin State Plumbing Code,in the performance of which all parties hereto agree to and are bound by said statutes.
• Application(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services,PO Box I 128,Oshkosh WI
54903-1128. Commencing wark without permit(s)will result in fees being doubled or$]00.00 plus the normal permit fee,which
ever is greater.
OR
If vou are a contractor participating in the Permit Fee Account Svstem and have adeguate funds, check here
if vou want this processed through your 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 submitted
with the permit application. Applications snbmitted without an EIV when such is reqnired, will not be
processed for Permit Issnance and will be returned for complerion.
Job Address • VaIUC(Including labor and materials)��� (J Date ��
Owner/�/QL�/U� � G Contractor �/C��/Y� x,�-c�y�ri�G r
�Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
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 Garage FD Surgeons Sink Waitrs Stn
Kit Sink Local Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker -
Dishwasher B�eakrm 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
C Gas 0 Elect�PwrVnt Floor Sink Drink Fntn Wtr Sewer MV
Clothes Wshr Hand Sink Wash Fnm Wtr Usage Mtr
Lndry Tray I.ab Sink Catch Basin Misc Fixtures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work /���� S/�/�/�/�jQ S��{/� ,/L
Size Material Type # Conn.Type ;
Sanitary Sewer y �f ��e G�j�L � �� �� '
Storm Sewer
Water Service
;
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