HomeMy WebLinkAbout1990-Plumbing (water heater) PERMIT - APPLICATION AND RECORD
TYPE: BLDG 7 HTG D ELEC E PLBG ' SIGN ❑ ZONING -- FLOOD PLAIN HEIGHT
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ADDRESS ^ '
_. PLAN NO.—..
OWNER f
DESIGNER..
USE/NATURE OF WORK
BUILDING CONTRACTOR—
y �
Size Sq. Ft, # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent 0 Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR.
Electric Serv. New ❑ Change ❑, Temp ❑ Type Volts Amps
Fixtures Swatches Receptacles _.... .. Circuits
PLUMBING CONTRACTOR
BT WVH Disp W80ft _ GBasln _
—.._.Lav Sh DW DF _..San. Sewer
�_. WC _FDr SP Ur Storm Sewer----
Sink _ LTub __..e_Eject SS Water ..
Other.
FEES: Valuation $, Permit Fee Paid S _ _ Park Dedication $
ISSUED By—, ,, Date e.......F ,.._ Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction,
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SIGNATURE ' "
AG ENT�OWNER DATE
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ADDRESS ter„--
TELEPHONE#
STATE OF WISCON'SIN �
Ss
W-=MBAGC CCUN'I"'.I' )
Name • Address
being first duly sworn on oath deposes and says that he is not
a licensed plumber, and that he has applied for a plumbing
permit to the plumbing Inspector of the City of Oshkosh, to do
plumbing work in a home owned and occupied by him, or a home
that is being constructed that is awned by him, and which will
be occupied by him as his home when completed. That he is not
building said home for the purpose of sale.
This affidavit is made for the purpose of complying with
the provisions of the plumbing code of the City of Oshkosh and
the State of Wisconsin, which provides that all plumbing work
must be doge by a licensed plumber except that the plumbing wort:
may be done by one who owns and occupies his own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the State of Wisconsin.
This affiant understands that the Plumbing work authorized
by the permit applied for, must be done only by this af'fiant and
that he cannot employ others who are not licensed plumbers to
assist with the worn.
Dated this 3 day of 4'4'e"�c 1.9 9
Subscribed and sworn to before me
this day ofAr
19
Notary FQblic, Winnebago County, Wisconsin
Icy Commission Expires: � � /