HomeMy WebLinkAbout0157869-Plumbing (water heater) � CITY OF OSHKOSH No �s7sss
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 919 MOUNT VERNON ST Owner ALYSSA NAST Create Date 09/20/2013
Contractor E C MERRILL INC Category 411 -Residential-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. 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 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 Drein _ 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 FR/REPLACE GAS WATER HEATER "check#12240
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Pa�cel Id#
1001850000
Valuation $84 00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided �
issued By � Date 09/20/2013
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
Agent/Owner
Address 809 WISCONSIN AVE N FOND DU LAC WI 54937 -0000 Telephone Number (920)921-4714
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 c f Gshkosh �
tnspection Services Division
P O E�cx 1130 �
u�hkash,W1 54903-1130 �
Phc�e: (920}236-�050 u
Fax: 1.�20) 236-5084 HK f I
ON �F-= WAT=R �
Plumbing Permit Application
[ hereby apply for a permit to do and install the following plumbing on the premises hereinafter described, the work to confonn to the
Wisconsin State Plumbing Code, in the performance of which all parties hereto agree to and are bound by said statutes.
• App:ication(s) and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services, PO Box 1 128,Oshkosh �'�'I
Sv903-11�8. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the normal permit fee, which
ever is greater.
OR
lf�ou are a contractor partrcipating in the Permit Fee Account Svstem and have adegua�e funds check here_
�,�ou ti��ant this�rocessed through your account n
** .Advisory-For applicable projects, an Eleetrical Installation Verification (EN) 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 submitted without an EN when snch is required, will not be
processed for Per�nit Issuance and will be returned for completion.
JO�� Address�� M� Y .UD� ST Va�Ue (Includinglaborand materials)� O�/f sU D�te � aG 3
O�r�ner � sS� Contractor �� ������C'/�G , �iYl�.
��;ingle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
tiumber of Fixtures:
Batlu�.,b Disposal Drink Fm Catch Basin _
w'hirlpool Disliwasher Wait.St. Wash Fm _
La�•atoti Sump Pump ice Chest Urinal ____
;�,i;e� EjeetodGrind Exam Sink Gar Drain ____._._
Re�.SinF: Water Softner Sculry Sink Soda Disp ____
E3a�Sink [.ocal Waste Hand Sink Coffee�taker ____
Wa:er Heater � Clothes Wshr F Prep Sink Comm.Ice Maker
�Gas��Elect�PwrVnt Bidet Serv Sinl< _ Site Drain
Shower Beer Tap Int Grease Trap Roof Drain ___.__
floor Drain Classrm Sink Ext Grease Trap 5t4ndp Rec
I.ndn Tray Surgeons Sink R.P.Z.Valve Gye Wash Sm
Lah S:nk Breakrm Sink Shamp Sink Wtr Sewer Mtrs ___
Plnster 5ink _ D�P We11 Flr/Vl+st Sink Deduct Meters
Steril;zer Hose Bibs Wtr l;sagc�1trs ____.
1�t:sc
Fixtu;es
Electric Contractor (for projects not requiring an EIV Form)
Use /Nature of Work �El�..�c�E Gt/�'�E�l�E�� �.�QOl, /��'!/T
Size Material Type # Conn. Type
I
� Sariitary Sewer i :
i
, Storrr Sewer i
I
; VJ2ter Service �
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