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HomeMy WebLinkAboutPlumbingPermit Plumbing Permit Application P O Box 1130 Oshkosh, WI 54903-1130 Phone: (920) 236-5050 www.oshkoshwi.gov Project Address ________________________________________________________________________________________ Applicant □ Owner □ Contractor □ Tenant □ Other (describe)__________________________________ Owner / Tenant Name__________________________________________________ Phone___________________________ Address_____________________________________________ Email______________________________ Contractor Company Name__________________________________________ Phone____________________________ Contact______________________________________________ Email_______________________________ Address___________________________________________________State Credential #’s_______________ Master Plumber Lic # Type □ New Building □ Water Heater □ New or Relocated Fixtures □ Replacement Fixtures Use □ Residential □ Commercial Number of Fixtures Project Description ________________________________________________________________________________________ ________________________________________________________________________________________ Value of Job $ ____________________ (Value for materials & labor is req. to ensure consistency in accessing permit fees for all applicants.) Payment by: □ Check #_______________ □ Cash □ Credit/Debit Card (office or online only) I certify the above information is complete and accurate. Any deviations from the above submitted information may require ad ditional permits to be obtained. I acknowledge and agree to these terms. Name: _____________________________________________ (Please print) Date: _______________________ Master Plumber’s Signature: ___________________________________________ ____Bar Sink ____Dip Well ____Hose Bibb ____Plaster Sink ____Surgeons Sink ____Bathtub ____Dishwasher ____Ice Chest ____Roof Drain ____Toilet ____Beer Tap ____Disposal ____Int Grease Trap ____San SumpPump ____Urinal ____Bidet ____Drinking Fount ____Kitchen Sink ____Sculry Sink ____Wait Station ____Break Rm Sink ____Exam Sink ____Lab Sink ____Service Sink ____Wash Fountain ____Catch Basin ____Ext Grease Trap ____Laundry Tray ____Shampoo Sink ____Water Heater ____CCC Assembly ____Eye Wash Stat ____Lavatory ____Shower □ Gas □ Elec □ Power Vent ____Class Rm Sink ____Food Prep Sink ____Local Waste ____Site Drain ____Water Sewer Meters ____Clothes Washer ____Floor Drain ____Soda Dispenser ____Water Softener ____Misc Fixtures ____Coffee Maker ____Floor Waste Sink ____Standpipe Rec ____Water Usage Meters ___________________ ____Comm Ice Maker ____Garage Drain ___________________ ____Sterilizer ____Whirlpool ____Deduct Meters ____Hand Sink ___________________ ____Sump Pump