HomeMy WebLinkAbout0158007-Plumbing (water heater - #A) /�"� CITY OF OSHKOSH No �ssoo7
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 635 STARBOARD CT WEST Owner BLACK WOLF INVESTMENTS LLC Create Date 09/30/2013
Contractor JOHN D RANSOM Category 446-Commercial-Water Heaters Plan
Inspector Jon Mueller
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. 0
Toilet 0 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 Grease Trap 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 1
Use/Nature j4-UNIT(APTA)/REPLACE ELECTRIC WATER HEATER, ELECTRICIAN IS SECKAR ELECTRIC **check#1979
of Work j
�
i
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1524901100
Valuation $375.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided �
Issued By (, � ► 1W Date 09/30/2013
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 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
AgenUOwner
Address W5056 PARADISE LN FOND DU LAC WI 54935 -9662 Telephone Number 920-922-1987
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 Oshl:osh �
Inspection Services Division � �
P O Box 1130
Oshkosh,WI�4903-I 130
Phone:{920)236-5050 �������-�
Fax: (920)236-�084
ON THE VJATeF
Plumbing Permit Application
I hereby appl}�for a pernut to do and install the following plumbing on the premises hereinafter described,the work to conforn:tu the
�'isconsin State Plumbing Code, in the performance of which all parties hereto agree to and are bound by said statutes.
• Application(s) and iee(s) can be brouoht to City Hall,Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI �4903-1128. 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 �articipatin� in. the Pormit Fee Account Svstem anrl ��ve �dPauate furds, check her� �
if l�ou ��ant tlzis processed throuQh vour account (�
Job Address CP�S// ��`�b OGr� �� �'alile{Inciuding laboT and materials) ��S p Date / -��o �l-3 .
O«�ner S�G�f �r2sf,o�P�-�S Contractor �0�►��0.i'�San"1
❑Single Family ❑Dupl��: �Malti-Famil�� ❑Rental ❑Commercial ❑Industrial
I�umber of Fi�tures:
Bzth?uo Lndry Standp Dent Oper. Shamp Sink ____
YVhirlpoo; --L)isp�sal Dip Well Flr/W'st Sink
Lavatoiti Dishwasher Drink Ftn Catch Basin ___
Toilet Sump Pump Wait.St. Wash Fm ___
Res.Sink Ejector/Gnnd Ice Chest Urinal ___.
�2-g��}; Water Sofiner Exam Sink Gar Drain
V2ater Heater 7L Local Waste Sculry Sink Soda Disp ___ _
G Gas�lect�:PwrVnc Clothes Wshr Hand Sink Coffee Maker ___._
Shower Bidet F Prep Sink Ice Maker ___
Floo;Drain Beer Tap Serv Sink Site Drain
Lndr}'Tray Classrm Sink Int Crrease Trap Roof Drain _ _
�°S''��' Surgeons Sin�; Ext Grease Trap Standp Rec ___
Plaster Sink B;ea]crm Sink
Ste;ilizer
Electric Contractor �Y'�n Se��'r' OR ❑Electric Installation Verification form attached
(If Replacement) �
Lse / �'ature of�'ori� re�p IG c e.. �")�r' h���TPY' ___j2Ff'�+�`7FIl--__-
-�
' Size ��'�aterial T}pe # Conn.Type i SEP 3 0 2013
'; Saniiar}�Se�ver �
� Storm Sewer DEPARTA1E�T OF �
', CO>1�tU�iTY DEVELOP:1fENT
I �'ater Service INSPECTiO�SERViCES Di�'ISIOy
�!o_