HomeMy WebLinkAbout0157954-Plumbing (sewer lateral) /�"� CITY OF OSHKOSH No 157954
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 106 WASHINGTON AVE Owner CITY OF OSHKOSH Create Date 09/27/2013
Contractor D.R. HANSEN PLBG. Category 444-Commercial-Exterior Laterals Plan
Inspector Jerry Fabisch
Bathtub 0 Clothes Wshr 0 Ciassrm 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 0
Use/Nature COMM/REPAIR DAMAGED SANITARY SEWER LATERAL
of Work
Size Material Type # Conn.Type
Sanitary Sewer 6" Plastic Lateral 1 Repaii
Storm Sewer
Water Service
Parcel Id#
0400510000
Valuation $3,000.00 Plan Approval _ $0.00 Permit Fees $0.00 ❑ Permit Voided �i
Issued By � �-'�� Date 09/27/2013
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 55 KNAPP ST OSHKOSH WI 54902 -3448 Telephone Number 233-1595
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
inspcction Services Divisi�a �
P O Box 1130 �
Oshicosh,WI 54903-I 130
Phone:(920)236-5050
Froc:(92Q)236-5084 K �
ON 7HE W/�TER
Plumbing Permit �pplication
I hcrcby spply for a permit to do and inst�tl thc foilowing plumbin�on the premis�s hcrcinaRcr dcscribcd,thc worlc to confnrm O�the
Wigconsin S�tc Plqmbing Code,in che perfarmancc of which all pArtics hereto�gree to and ar+e bound by said stanitd.
• Applicacioe(e)end fee(s)can be bronght to City Hall,Room 205 or mailed to Inspcction Servic�s,�O Box 1128,Oshlt�osh WI `
54903-1128. Cornmencing work without permit(s)will result in fecs bcing doublal or 5100.00 plus thc normal permit fcc,which
cvcr is greata.
OR
,(ty�u are a contraclor_particindlJnp in t e P��„1i� Fee Accou�t Svslem and have adeau�{l�,funds. check here
�vou wanl Ihis proccssel! Jhl'�u�h vq,�r o�counl n
**Advisory-For a�licablc�vjcds, an E1ec�ical?nstaiXatirna Vet7l6cation(EIV}foffi,si�ned b�tb�e E�ecbnical
Comtx^acto�o�k�rnneowncr(far ias-tallati.ons allowed to be�►ex�o�nad by thc homcowner)mnst be snb�oa�ltted
wi8►the pe�nnni�t ap�lication. AppXications sab�ed witdxo�an EIV whm svch is reqnired,will not be
processed fot Pe�nuaitt�SSaan,ce sa�d witl be reivrned for co�u��etio�. .
Job Ac�dr�ss�0,� �-Value(r►�ivai���a��c��,�� b a.Dl� Date nl � �
Owner C��� D Sl.k C�_ _ ContrACto�- � - �.
�Single Farnfly ❑Daplcx ❑Malt�-Family []R�ntal �;Commcrcial D�adostrisl
Nnmber of Fi�tures: �
B�thtub Scnnp Puinp Plastcr Sink Roof Droin
Shmvar San.Sump/Pump 5cullery Sink Soda Diap
whirlp�l Walcr SoRatcr 9crvicc Sink CofTcc Mkr
Lavatory St9ndpipe Rec Shemp Sink 3ite Dn'v�
7oilcl " GnraRn FA Surgcams Sink Waitrs 9m
Klt Sink L.�rnl wa�te StcrlHaer Tce Che,.t
- Diapoael Dor Smk RPZ Valvc Comm tce Maltcr
pr��hu Bre�krm Sink Bidd fnl(�rense Trnp
Floor Drain Clnx�m Sink Urinal • blct[��asc'It�p
Hoc�e Bibb Exam Sink Be�x Tap F,}�e w�Stn
Woter Fleator F Pccp Sink Dlpper Well Deduct Mcur
❑Gae O Elak❑PwrVnt Floor 3ink Drink Fetn Wu'Sew�er Mtr .
C�otlx�s Wshr (t�nd Sink ' . Wastt En6n : • Wtr Usage MV .
��Y T�Y LaD 5ink Celch 8sein , Misc Fi�cnms
Elect�ric Coetracto�(�'or pr jects not re�qairing an EIV Form)
Use/Natnrc of Work �� C� �� ✓
Sizc Matenial Typc #, _, Conn.Type '
SAnitary 5cwcr
Storm scwcr
Watcr Scrvicc
06/09