HomeMy WebLinkAbout0158666-Plumbing (repair lateral) � CITY OF OSHKOSH €
� No 158666
: OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 2590 OLD ALEX CT _ Owner BRADLEY J/TAMMY J THOMAS Create Date 11/07/2013
Contractor BERNDT EXCAVATING _ Category 401 -Residential-E�erior(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 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 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\Repair 1"lateral
of Work
i
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
i
Water Service 1" Copper Lateral 1 Repaii
Parcel Id#
1381470000
Valuation $1,500.00 Plan Approval $0.00 Permit Fees $50.00 ❑ Permit Voided' {
Issued By /-� Date 11/07/2013
;
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 s ur a y ne ary ap tarting such activity. � /�
Signature p �� 1�-'—'�-�p���� Date l l � ?
AgenUOwner �
Address 2430 W WAUKAU AVE OSHKOSH WI 54904 -8985 Telephone Number (920)235-3331
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. ;
r
�
City of Oshkosh
Inspection Services Division �
P O Box 1130 �
Oshkosh,WI 54903-1130
Phone:(920)236-5050
Fa�c:(920)236-5084 �S�K���--�
ON THE WATER
Plumbing Permit Application
I hereby apply for a permit to do and install the following 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
If vou are a contractor participatin� in the Permit Fee Account Svstem and have adeguate funds, check here
if vou want this n�•ocessed through vour account n
**Advisory-For applicable projects, an Electrical Installation Verification(EI�form, signed by the Electrical E
Contractor or Homeowner(for installations allowed to be performed by the homeowner)mnst be snbmitted '
with the permit application. Applications snbmitted without an EIV when such is reqnired, will not be
processed for Permit Issnance and will be retarned for completion.
��`�� o�d �+ ��� c�, � �� � 1�, 7�f3
Job Address Va�UC(Including labor and matenals) � Date
Owner � �"`�_`��y �o� QS Contractor
�]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
L,avatory Standpipe Rec Shamp Sink Site Drain
Toilet Garage FD Surgeons Sink Waitrs Stn
Kit Sink I.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
❑Gas CJ Elect C PwrVnt Floor Sink Drink Fntn Wtr Sewer Mtr
Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr
Lndry Tray Iab Sink Catch Basin Misc Fixtures
Electric Contractor(for projects not requiring an EIV Form)
Use/Nature of Work � l x V'� °��� '�' 1 L� �
Size Material Type # Conn.Type
Sanitary Sewer
Storrr►Sewer
Water Service
� Ir ��p�� � �
06/09