HomeMy WebLinkAbout0105103-PlumbingRpr 02 02 09:23a Oshkosh InspectJon~ 920-23S-508~ p.~
City of Oshkosh
Iuspection Services Division
POBox 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax; (920) 236-5084
Q/HKO/H
Plumbing Permit Application
I hereby apply for a pemfit to do and install the following plumbing on the premises hezeinafter described_ ~he work to conform to the
Wisconsin State Plumbing Code,/n 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 be/ns doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
ff you are a contractor participating in the Permit Fee Account System and have adequate funds, cheek here
if you want this processed through Four account [~
Owner /'~t°,/~-~ W£57"g',*?,~/~".,O--- Contractor ~/o~g~- ,~//,pW/~g ,x;~,~a~:7~$
~Single Family [~Duplex [~]Multi-Family ['-]Rental ' [~]Commercial [~Industrial
NumberofFixtures: ~Z /A/ /ff~r~f/~ ~ -2~-5'~/~
Bathtub Lndry Smndp Dent. Oper. Shamp Sink
Whirlpool Disposal Dip Well FIr/Wst Sink
kavalory ~ Dish ~sher Drink Fm C~tch Basin
Toilet X Sump Pump Wait. St. ~ Wash Fm
Res. Sink Ejector/Grind lee Chest U:/nal
Bar Sink Waler $ofmcr Exam Sink Gar Drain
Water .qeater Local Waste SculD'Sink Soda Disp
v'
Sterilizer
Electric Contractor
Use / Nature of Work
Samtary Sewer
Storm Sewer
Water Service
OR
[--~Electric Installation Verification form attached
(If Replacement)
Size Material
Type # Conn. Type