HomeMy WebLinkAbout0159146-Plumbing (disposal) � CITY OF OSHKOSH No 159146
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
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Job Address 1633 DOEMEL ST Owner WILLIAM J BOLLOM Create Date 12/26/2013
Contractor 0 R GLAZE PLUMBING Category 410-Residential-Interior 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 FINWst 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 1 Gar Drain 0 Piaster Sink 0 Dip Well 0 Comm Ice Maker 0 ;
Dishwasher 0 Local Waste
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/Replace ISE disposal
of Work
�*Paid by check#1244 �
(
: Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1514180000
Valuation $425.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided'
issued By pS Date 12/26/2013
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 1865 JAMES RD OSHKOSH WI 54904 -6873 Telephone Number 920-589-4014
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. €
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Cit}�of Oslilcosli n
Iuspectioa Sen-ices Dn-ision U C # ���� �
P O Box 1130 � _
Oshkoa-�i,�'VI 5-1903-1130 �3b� #
: Phoiie: (920)236-5050 ���?��13 u _
Fa�c: (930)236-5�3-t HK f�
ON THF WATFR
Plumbing Permit Application
I liereby apphr for a pe�xuit to do wd iu�all the follo�vuis pinmUius ou the premises hereviafter desc�ibed,die�a-ork to confotYn to the
�i�iscousni State PluiuUiu,Code,in the pe��o�YUUice of��i�icl�all puties hei�eto a,ree to wd�u•e bouud by said stahrtes.
• Applicatiou(s)<md fee(s)cui Ue broii�t to City Hall,Rooui 20S oi•u►ailed to Iuspectiou Seiti-ices,PO Box 1133,Oslil:o�«'I
5=�903-11?3. Commenciu;�vo�1:«-ithout pe��uiit(s)�vill re��ilt ui fees beni,douUled or$100.00 plus die iio�Ynal pe��uiit fee,«-1�icli
e�-er is�-eater.
OR
If vou are a contractor �artictpaltnQ in the Permit Fee Account Svstem and have adequate,�'unds check here
if vou want this Drocessed through your account n
**Advisory-For applicable projects, aa Electrical Installation Vetification(EIV�form, signed by t�e Electrical
Contractor ar Hameowner(for installat�ions allowed to be pelfarmed by the homeowner)must be submitted
with the permit application. Applications submitted withaut an EIV when such is required,will not be
processed for Penmit Issuance and will be retyttned far completion.
Job �ddress ��3-3 � � `'aIUC(Including labor andmaterials)����,_� D�te � �_13
DCi,1Et �
. �Wner �1�( lJOLLDM Contractor � ��L.�(,�jL� �r,..��(�r
� 'ii�le Famin ❑Duplea �1bIulti-Famil� ❑Rent�l ❑C'ommei•ciai ❑L�dustrial
Number of Fiatures:
Bathtub Sump Pump Plaster Sink Roof Drain
Shower San.SumplPump _�.,_ Scullery Sink �� Soda Disp _
Whirlpool Water SoRener Seroice Sink Coffee Mkr
Lavatory Standpipe Rec Shaznp Sink Site Drazn
Toilet Garage FD Surgeons Sink Waitrs Stn
. Rit Sink Local Waste Sterilizer Ice Chest
Disposal r Baz Sink RPZ Valve Comm Ice Maker
Dishwasher Breakrm Sink Bidet Int Grease Trap
F1oorDrain Classrm Sink Urinal Ext Grease Trap
Hose Bibb Exam Sink Beer Tap __ Eye Wash Stn
WaterHeater F Prep Sink Dipper Well DeductMeter
Gas Elect PcvrVnt Floor Sink Drink Fntn Wtr Sewer M� f
Clothes Wshr Hand Sink Wash Fntn Wtr Usage Mtr �
Lndry Tray Lab Sink Catch Basin Misc Fixtures ;
Electric Contr�ctor (for projects not requiring an EI�' Form)
tlse/N�ture of�`'ork ��E��t,,c� �� r��s�i��,
Size Ai�terial T}�e Couu.T}�e
Swit�y Se«er
Stonu Se�tiei•
�t'ater Seivice
06/09
«
� City of Oshkosh
� Division of Inspection Services
215 Church Avenue
PO Boxll30
Oshkosh V✓I 54903-1130
�( u Office 920-236-5050
�� � � Fax 920-236-5084
ON IHt WAItN -
Electric Installation Verification :
I(We) MY Electric Corp.
(Electrical Contractor Name)
6012 Koelpin Rd. Oshkosh WI 54902
(Address) (Ciry) (State) (Zip Code)
have been contracted to perform electric installation work for Bill Bollom ,
(Name of party contracted to)
at the following address: 1633 Doemel Ave.
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding/soffit installation. Note: New Service
Entrance Cables will require a separate permit.
Reconnection or new circuit for the replacement of other permanently wired `
appliances/fixtures.
New circuit for the addition of A/C to an individual dwelling unit(house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
X Other
Connection of sink disposer.
The value of this work is $299.00
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection/installation will be done in compliance with manufacturer and Electric code
requirements.
)
.
Eric Youngbauer December 18, 2013
(Signature f Compa Officer) (Print Name of Officer) (Date)
5/02