HomeMy WebLinkAbout0101850-Plumbing (dishwasher)OSHKOSH
ON THE WATER
.lob Address 3857 WESTERN DR
Contractor RAPID SOFT LLC
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
Owner GORDON/DOROTHY ZWICKY
Category 410 - Residential-Interior
Bathtub 0 Shower 0 Ejector/Grind 0 DipWell 0 F Prep Sink 0
Whirlpool 0 Floor Drain 0 Water Soffner 0 Drink Ftn 0 Serv Sink 0
Lavatory 0 Lndry Tray 0 LocalWaste 0 Wait. St. 0 Shamp Sink 0
Toilet 0 Lndry Stndp 0 ClothesWshr 0 Ice Chest 0 FIr/Wst Sink 0
Res. Sink 0 Disposal 0 Bidet 0 Exam Sink 0 Catch Basin 0
Bar Sink 0 Dishwasher 1 Beer Tap 0 SculrySink 0 Wash Ftn 0
Water Heater 0 Sump Pump 0 Dent. Oper. 0 Hand Sink 0 Urinal 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
No 101850
Create Date 05/30/2003
Plan
Gar Drain
Soda Disp
Coffee Maker
Int Grease Trap
Ext Grease Trap
Use/Nature SFR/Replace dishwasher for Sears. *EIV form from homeowner.
of Work
Valuation
Issued By
Sanitary Sewer
Storm Sewer
Water Service
Size Material Type #
$600.00 Plan Approval $0.00 Permit Fees
Conn. Type
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$20.00
Date
05/30/2003
Permit Voided
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address P.O. BOX4052 APPLETON WI 54915 - 0052 Telephone Number
920-757-6432
City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
Offt-tl(O/H
THE W^?ER
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 partieshereto 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 11'28,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $I00.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor..participating in the Permj~.t Fee Account System and have adequa, te funds, check here
if you want this.processed through your account ..[-]
Job Address~.~ f-- j'-7 L~,.)~-~ .~-. Value (~ncl-aing lahor and mat~iais) ~C5'O ~ a Date~-')~ ~:~d
Owner ~ ~.j 2 c.-,~..t Contractor"'~;C~-Fc~--Z;~ c_.
~}Single Family F-lDup~x [--lMuiti-Family [-'lRental [--]Commercial [--]Industrial
Number of Fixtures:
Bathtub Lndry Standp Dent. Oper. Shamp Sink
Whirlpool Disposal Dip Well FlrlWst Sink
Lavatory Dishwasher I Drink Ftn Ca~:h Basin
Toilet Sump Pump Wait. St. Wash Ftn
Res. Sink Ejector/Grind Ice Chest Urinal
Bar Sink Water Softner Exam Sink Gar Drain
Water Heater Local Waste Sculry Sink Soda Disp
B Gas E Elect [] PwrVnt Clothes Wshr Hand Sink Coffee Maker
Shower Bidet F Prep Si~k Ice Maker
Floor Drain Beer Tap Scrv Sink Site Drain
Lndry Tray Classrm Sink Iht Grease Trap Roof Drain
Lab Sink Surgeons Sink Ext Grease Trap Standp Rec
Plaster Sink Breakrm Sink
Sterilizer
Electric Contractor
Use / Nature of Work
Sanitary Sewer
Storm Sewer
Size
O'R ~Electric Installation Verificati6n form attached
t (If Replacement)
Material Type # Conn. Type
Water Service
O),OB:40a Code
920-236-5084
Electric Installation Verification
(print homeowner(s) name)
the homeowner(s) of .~ ,~"7 /4/~"~57~ tV~ Z~),~
(address where work is to be performed)
accept the responsibility for performing the electrical-work as stated below for the property listed
above.
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.
Reconnect'ion of the Serv/ce Entrance Cable, Meter Box, alt~afions to receptacles
and lighting fixtures due to siding / soffit installalion. Note: New Service
Entrance Cables will require a separate permit.
Reconnecfion or new circuit for other permanently wired appliances / fixtures.
Other
The value of this work is $
I hereby verify this work will be performed by me and further verify the reconnection /
installation will be done m compliance with manufacturer and Electric code requirements.
(Date)