HomeMy WebLinkAbout0158142-Plumbing (laterals) � CITY OF OSHKOSH No 158142
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1621 HICKORY ST Owner CHARLES E/SUSAN K/SCOTT A DOEMEL Create Date 10/08/2013
Contractor KELDERMAN PLUMBING __ Category 401 -Residential-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 FldWst Sink 0 Bidet 0 Site Drain 0 Misc. p
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
Disposai 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 0
Use/Nature �SFR/Running water lateral and interior water service. �
of Work �
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer '
Water Service 1" Plastic Lateral 1 New
Parcel Id#
1512850000
Valuation 1,500.00 Plan Approval _$0.00 Permit Fees $50.00 ❑ Permit Voided,
Issued By Date 10/OS/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 w' '�a3ement,the 'y st gly urges the permit applicant to contact the :
easement holder(s)and to s an �ry a s e starting such activity.
Signature — Date Q-��
Agent/Owner
Address W5 07 AMY AVE SUITE 3 KAUKAUNA WI 54130 -0000 Telephone Number (920)450-5398(cell)
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 �
F�:�9zo,z,6-so84 OlHKO H �
ON THE WATER �
Plumbing Permit Application
I hereby apply for a permit to do and install the fotlowing 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
Ifvou are a contractor participatinQ in the Permit Fee Account Svstem and have adequate funds check here
i1'vou want this p�•ocessed through vour account n
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Electrical
Con�actor or Homeowner(for installations allowed to be performed by the homeowner)must be submitted
with the permit application. Applications snbmitted without an EIV when snch is reqnired, will not be
processed for Permit Issnance and will be retarned for compledon.
` l /�� •o
Job Address / i ,f' r S VaIUe([ncluding labor and materia s 5(/L/ Date����/3
Owner Contractor � Q �
�,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 L,ocal Waste Sterilizer Ice Chest
Disposal Bar Sink RPZ Valve Comm Ice Maker
Dishwasher Breakrm 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 C Elect�PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray Iab Sink Catch Basin Misc Fi�ctures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
06/09