HomeMy WebLinkAbout2013-Plumbing (backflow assemblies) � CITY OF OSHKOSH No 159175
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1465 S WASHBURN ST Owner STEINERT PROPERTY HOLDINGS LLC Create Date 12l31/2013
Contractor KURT ZENTNER 8 SONS INC Category 442-Commercial-Interior(New/Relocated Fixt� 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 2 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 0 San Sump/Pump 0 FIr/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 O lce 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/install(2)backflow assemblies per Hydro Designs survey -�
of Work
'*debit acct�'
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcel Id#
1311760000
Valuation $500.00 Plan Approval $0.00 Permit Fees $30.00 ❑ Permit Voided I
Issued By �- Date 12/31/2013
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party,if you perform the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the
easement holder(s)and to secure any necessary approvals before starting such activity. :
Signature Date
AgenUOwner
Address 2860 OREGON ST OSHKOSH WI 54902 -7136 Telephone Number 235-1340
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not perFormed within two business days from the time the project is ready.
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Ciry of Osfikoah �
Insp�crion Serrices Division �
P 0 Bac 1130
Oshkosh,WL 54903-1130
, Phone:(920)736-5050
Fax:(920)236-SO&4
pN TH WATEN
Plumbing Permit Application
I hereby apply for a permit to do and mstsll the following plwoabv►g ot�th�Pre�s�h��►�T�SCnb�d,the vvotic to coqform Lo the
V,risconsin State Plumbia$Code,ian the performanee of which all pardes hereeo agrcc to and are ba�md by said statutes.
• Applicatioa,{s)and fee(s)can be brougLt to City Hall,Room ZOS or mailcd to Inspcctioa Services,PO Bax 1128,Oshkesh WI
54903-t 128� Commencing work withouc pcamc(s)wal nsnit m fees bemg donblcd ot 5100.00 pins the normal peruut fee,which
ever is�reater-
OR
1 o are a ntract r arti ' arin 'n the er»ii ee Ac rent tem d ha ade t¢ d's c eck r�
i o ant ro ed th h r acc nt
**Advispry.Fo�applicable project��az�IIeedalcal Installation Verificatioa(EI��orm,signed b9'the Electrical
Comt�ractox or Hom�eo�vner(for installaiim�s�owed to be pe�'ornied bY the homeowaer)mnst be snbmit��
ract �1 not be
with the pexmft aPPheation. Applications snbmitted withoat aa EN whea sach is required,
pxocessed for Pexa►it Iasa1nce and aill be reta�ed for wmpletion,
rob Address l y�.S� a S� Value(r�auamg��r ffia��) �04�� I}ate�2 30 13
Owner S � � ' Co�tractor K ` �,�s
�ialti-F �Rental �Commercial �Indastrial
❑S�ngle Famity �Auplez �Y
Number of F�atares:
S��p Pisster Sioli Aooflhaiu
�� Sadlep'Siak S°ds A�p
Shoaa 5ao'�°p�p CoNke 1u[1v
�� Wak�Softeaa S�ce Sidc
5���� Shamp Sink Site Dram
�'r"�0'S' waias sm
To�el Ga�age FD Stitrgeone Siok
�t s�
�w�� s� cu ce�
a�s� �ez v� co,�►r�n�a
n,sp°sal B� In�c�as�Trav
�� 9realQm Smk U� FactQr�aie'Itap
�� Closgm Sink gye W esh Sm
E�cam Sink Beer'Cep
Hose Bbb p��W� p�dudMetcr :
WaterHeaca F�� .
❑Ges 0 Slect 0 ParVn� Floor Sink Dtink�om Wor Scwer Mcr
Clothes Wsl�t Head Sm�
Wssh Fam a+�'Usagc Mv
L,adry TrnY T.ab 9ink Catch�sain M�ec F'ucn�es
Electric Contracto�r(for projeMs not requ�riag an Erv Forn�)
YTse/Natu�re of Work �ro S �
��°n �n..s�// Z, v� �� _
Size Material Type # ComL'1}�pe
Sanitarq Sewu
Storm Scwer
Water Scrvice
06/09
%
6
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