HomeMy WebLinkAbout0158345-Plumbing � CITY OF OSHKOSH No 158345
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1095 N WESTFIELD ST Owner EVERGREEN MANOR INC Create Date 10/17/2013
Contractor HURCKMAN MECHANICAL INDUSTRIES, INC. Category 442-Commercial-Interior(New/Relocated Fixt� Plan state review
Inspector Jerry Fabisch
Bathtub 0 Clothes Wshr 0 Classrm Sink 0 Surgeons Sink 0 Roof Drain 0 Deduct Meters 0
Shower 1 Lndry Tray 0 Exam Sink 0 Sterilizer 0 Soda Disp 0 Wtr Sewer Mtrs 0
Whiripool 0 Sump Pump _ 0 F Prep Sink 0 RPZ Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 21 San Sump/Pump 0 Flr/Wst Sink 0 Bidet 0 Site Drain 0 Misc. p
Toilet 21 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 Locai Waste 0 Sculry Sink 0 Drink Ftn 0 Int Grease Trap 0
Floor Drain 0 Bar Sink 0 Serv Sink 2 Wash Ftn 0 Ext Grease Trap 0
Hose Bibb 2 Breakrm Sink 0 Shamp Sink 1 Catch Basin 0 Eye Wash Statn 0
Water Heater 2
Use/Nature OMM/EVERGREEN/PHASE III/Interior plumbing associated with the remodel of elderly living units per state
of Work iapproved plans "check#39283
I �
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Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1608630000
Valuation $78,900. 0 Plan Approval $0.00 Permit Fees $450.00 ❑ Permit Voided �
Issued By Date 10/18/2013
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 P O BOX 10977 GREEN BAY WI 54307 -0977 Telephone Number 920-499-6984 EXT 1
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 i 13Q �
Oshkosh,WI 54903-1 1 30 �
Phone:(920)236-5050
��:tsa.���c-s� � � H
Plumbing Permit Application �N 7HF WATFR :
1 herehy aPPly for a permit to d�t and instai}the fol}owing p}umbing on the pFe�nises herei�atter deser�bed,the work to eo�orm 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 Giiy Hall,Room 205 or mailed to Inspection Se�-yices,PO Box 1128,Oshkosh WI
54903-1128. Commencing work without permit(s)wiil result in fees being doubled or$100.00 plus the normal permit fee,which
ever is greater.
QR
ILvou are a contractor narticiaating in the Permit Fee Account Svstem and have adequate funds check here
:f vou wctnt thrs nrocessed throuQh your account rl
**Advisory-For applicable projects,an Electrical Installation Verificatlon(EI�foim,si�ned bY the Elerlrical
Co�a�ctor or Homeowner(for installadons allowed to be i�oe
�t1�e��E_:��,..� P�ormed by the homeowner)mast be snbmitted
������ae�F�V�����eg�ed,��m�t lie
pmce�ed for Pem�it Issnaace and w�l be returned for rnmpletion.
Sharehaven
dob Add�ess 4�estfi�ld Valee���va;,�,�t�r�d,��s} $78,9D0 �ate 10/14h 3
Owner Evergreen Retirement Community Contractor Hurckman Mechani�at Ind�strie� inc
❑Singlc FamilX DDuplcx [�Mutti Eamity �]Rcntal [�Commcrciat [�ladustri�
Number of Fixtures:
f3a�tub Sump Yump f'laster Sink Roof Ihain
Shower _..L__ San.Sump✓PumP Scullery Sink
Soda Disp
���P°O� Water Softener
i.�v�tu€y 21 Service sink 2 eoffee Mkr
�� Sham�.Sinlc _� Sit�Drain
Toilet �]� Garage FD Surgeons Sink Waitrs Sm
Kit Sink L�W��
Sterilizer Ice Chest
Dis�osai liar Sinl: lLY'L Valve Comm lce Maker
Dishwasher Breakrm Sink Bidet Int Grease Trap
Floor Drnin Classm Sink Urinal E�ct Cmase Trap
1�se f�6 2 E�m Sink &nr Tap Eye Wash Stn
Waber Heater 2 F Prep Sink Dipper Well ���t
�C'ias 0 Elect�(,PwrVm Floor Sink ��F�
Wtr Sewer Mtr
Clotfies Wshr Iiami Sink Wash Fnin
��T�y VVtr Usage ivltr
Lab Sink Catch Basin �F�
Electric Contractor(for projects not reqairing an EIV Form)
Use/Nature of Wark Q���;�Re�P� � D vv
S� Material Type # Conn.Type
Sanit�y Sewer ��� IV�.�
Storm Sewer
water servi� 0 C T 5 2 013
UEPART11E1T OF
�'l n�� C0�7�iU�iTX DE\'EI.OP�IEVT
� V�� l� INSPECTIOti SER�'10ES DI�'IS10�!
�/� 06/09
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