HomeMy WebLinkAbout0158342-Plumbing � CITY OF OSHKOSH No 158342
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Owner EVERGREEN RETIREMENT COMM 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 10 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 10 San Sump/Pump 0 Flr/Wst Sink 0 Bidet 0 Site Drain 0 Misc. p
Toilet 10 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. � Fixtures
Kit Sink 12 Standp Rec 0 Lab Sink 0 Beer Tap 0 Ice Chest 0
Disposal 12 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 1 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/EVERGREEN(GARDENS)Interior plumbing associated with the remodel of elderly living units per state
of Work !approved plans '*check#39283
i
I
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1615311000
Valuation $98,300.00 Plan Approval _ $0.00 Permit Fees $495.00 ❑ Permit Voided I
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 Teiephone 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 113Q
Oshkosh,WI 54903-1130 �
Phone:(920)236-5050
F�t�a.a����as� �—H
Plumbing Permit Application ��T~F WATF�
I hereby aPp(Y fur a permit tu du and instal!the foituwing plumbir►�on th�premises hereinal��r deseribuf,the wcxk t�c:vnfe�rm to the
Wisconsin State Plumbing Code,in the performance of which all parties hereto agree to and are bound by said statutes.
• Applicalion(s)and fee(s)can be brought to City Ha11,Room 205 or mailed tn inspection Services,Pfl Bnx 1 i�8,flshkt�sh WI
54903-1128. Commencing work without petmit(s)will result in fees being doubled or$100.00 plus the normal permit fee,which
ever is greater.
OR
11 vou are a contractor nartieinatine in the Permit Fee Aecount Svstem and have adeguate funds check here
rf vou want thrs processed through vour account (—)
'r''Advisory-For applicable projects,an Electrical Installatton Venification(EI�form,sigaed by the Electricai
Cont�actor or Homeowner(for installa�ions allowed ta be petforimed by the homeowner)most be sabmitted
v��the P���-, Ag��Cat�r��d��t a�����i��t�i��t�
processed for Penmi#Issoance and w�l be retnrned f»r completion.
TheGardens �13� N westfie1d
Job Address ��N �aQip c� Value{i�j„d;�ia�and��ts� $98,3Q0 _ Date 10l10/73
Owner Evergreen Retirement Community Contractor Hurckman Mechanical Ind�s ' � �►+�
QSiagie Fxmi}y QDie� a�Viulti-Fu�elx [(Reu�l QE��ereix� �
[1 at�tris�
Namber of Fiatures:
8athtub Surtt�Pnmp Plaster Sink
Rcu�f Drain
Slwwer �Q_ San.SumP/Pun►P Scullery Sink Soda Dis
P
Whirlpool Water Softener Service Sink � Coffee Mkr
L8K3ft�i �Q Sf$flE�}{�'.R@€ S�ff1i}�.5�#fi� SFEC DfBtt� ,
Toilet �Q_ Garsge FD Surgeons Sink Waitrs Stn
Kit Sink 12 Locat Waste Sterilizer Ice Chest
�sPo� .�� 8ar Sink RP7.Valve Comm Ice Maker
Dishwasher Bteaktm Sink Bidet Int Grease Trap
Floor Drain Classrm Sink Urinai Ext Grease Ttap
Ei�B� E�_�ink- Bee�Tsp �ye Wasl�-3th
Water Heater F Prep Sink Dipper Well Deduct Meter
❑Gas 0 Elect�PwrV►tt Floor Sink Drink Fntn
Wtr Sewer Mtr
Clothes 1�Vshr Hanii Sink Wash Fnln Wtr Usage Mtr
Lndr�'T�aY Lab Sink Catch Basin Misc FnRures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of�Vork ptumbina Remode► (� ��DU
Size Material Type # ��.Ty�
�"'`�`'�s'�„►`� RECEIV I)
Storm Sewer
����'i� OCT 15 2 13
DEPART;�tE�7 OF
C0�9�1UVITY DEVELOP�1EVT
� S�' .���G , INSPECTIOV SER�'10E5 DI�'ISIOV
O6/09