HomeMy WebLinkAbout0102517 POSHKOSH
ON THE WATER
Job Address 60 JACOB AVE
Contractor HOMEOWNER
Bathtub 1 Shower
Whirlpool 0 Floor Drain
Lavatory 1 Lndry Tray
Toilet 1 Lndry Stndp
Res. Sink 0 Disposal
Bar Sink 0 Dishwasher
Water Heater 0 Sump Pump
Site Drain 0 Classrm Sink
Roof Drain 0 Breakrm Sink
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
No 102517
Owner JOSEPH M/SHANNO REPKA Create Date
Category 410 - Residential-Interior Plan
0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0 Gar Drain
0 WaterSoftner 0 Drink Ftn 0 ServSink 0 Soda Disp
0 LocaIWaste 0 Wait. St. 0 Shamp Sink 0 Coffee Maker
0 CIothesWshr 0 Ice Chest 0 FIr/Wst Sink 0 Int GreaseTrap
0 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap
0 Beer Tap 0 SculrySink 0 Wash Ftn 0
0 Dent. Oper. 0 Hand Sink 0 Urinal 0
0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
06/30/2003
Use/Nature Install Full Bath in Basement.
of Work
Valuation
Issued By
Storm Water
$1,000.00
Size Material Type
Plan Approval $0.00
Permit Fees
# Conn. Type
$20.00
Date
06/30/2003
Permit Voided
The undersigned, in applying for a plumbing permit to install plumbing in a single family home owned and occupied as the
principle residence of the undersigned, hereby acknowledges, per Wisconsin State Statutes, ss 145.06, that other individuals
will not be employed to assist with the work described by this permit. If an individual will be employed to install plumbing
the work involved must be covered by a permit issued to a properly licensed Master Plumber.
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 60 JACOB AVE OSHKOSH WI 54902 0000 Telephone Number
OSHKOSH
ON THE WATER
Job Address 60 JACOB AVE
Contractor HOMEOWNER
Bathtub 1 Shower 0 Ejector/Grind
Whirlpool 0 Floor Drain 0 Water Softner
Lavatory 1 Lndry Tray 0 Local Waste
Toilet I Lndry Stndp 0 Clothes Wshr __
Res, Sink 0 Disposal 0 Bidet
BarSink 0 Dishwasher 0 Beer Tap
Water Heater 0 Sump Pump 0 Dent. Oper,
Site Drain 0 Classrm Sink 0 Lab Sink
Roof Drain 0 Breakrm Sink 0 Sterilizer
CITY OF OSHKOSH
PLUMBING PERMIT - APPLICATION AND RECORD
Owner JOSEPH M/SHANNO REPKA
Category 410 - Residential-Interior
0 Dip Well 0 FPrepSink __
0 Drink Ftn 0 ServSink
0 Wait. St. 0 ShampSink __
0 Ice Chest 0 FIr/WstSink __
0 Exam Sink 0 Catch Basin __
0 SculrySink 0 Wash Ftn
0 Hand Sink 0 Urinal
0 Plaster Sink 0 Standp Rec __
0 Surgeons Sink 0 Ice Maker
No 102517
Create Date 06/30/2003
Plan
0 Gar Drain 0
0 Soda Disp 0
0 Coffee Maker 0
0 Int GreaseTrap 0
0 Ext Grease Trap 0
0
0
0
0
Use/Nature
of Work
Install Full Bath in Basement.
Storm Water
Size Material Type
# Conn. Type
0
0
0
0
0
Valuation $1,000.00 Plan Approval $0.00 Permit Fees $20.00
Issued By ~
[] Permit Voided I
Date 06/30/2003
The undersigned, in applying for a plumbing permit to install plumbing in a single family home owned and occupied as the
principle residence of the undersigned, hereby acknowledges, per Wisconsin State Statutes, ss 145.06, that other individuals
will not be employed to assist with the work described by this permit. If an individual will be employed to install plumbing
the work involved must be covered by a permit issued to a properly licensed Master Plumber.
in the perforf~c~f this~[~l a~_e to perform all work pursuant to rules goveming the described c°nstructi°n'
Signature ~,.,~,.~'~ ~ "~ t Date
[ Agent/Owner
Address 60 JACOB AVE OSHKOSH WI 54902 0000 Telephone Number