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~ PERMIT - APPLICATION AND RECORD
~C~"=~ Address ILID 7 {p 3 r/ Afve
CITY OF OSHKOSH
Owner ~es ~ 1/1171 ff
15691
Lot
Type of Permit:
Block
Ward Subdivision
Heating 0 Piumbing~ Sign 0
Building 0
Electrical 0
Nature of Work
PLUMBING CONTRACTOR / Q
Bu. San. Sewer - Curb to Bu.
Bu. SI. Sewer Curb to Bu.
Sewer Fees
Water Service
Bath Tub Floor Drain Urinal
Wash Basin - Garbage Disp. - S. Sink
Water Closet - Dish Washer - Catch Basin
Kit. Sink Laundry Mach. - S. Pump -
Water Heater ------I---- Water Soft. B & S Waste -
Shower Bath - Bubbler Conductors
Plumbing Fees Total Fees
.w
HEATING CONTRACTOR
Fuel: Gas 0 Oil 0 Elec. 0 Solar 0 Solid 0
Conditioning Forced Air 0 HW. 0 Elec. Base 0 Steam 0 Radiant 0
System High Eff. 0 Supplementary 0 Air Condo 0 Ventilation 0
Chimney: "A" 0 "B" 0 Direct Vent 0 Con. Burner 0 Flue Damper & E./. 0
Calculated Heat Loss System BTU Rating
ELECTRIC CONTRACTOR
Electric Service: New
Description-Type
Fixtures-
Appliances
Changes
Temp.
Volts
Recep's
Amps
Circ's
Switches
Electrical Signs
N~
Zoning
Insp.
Id. No.
Flood Plain
Wrecking 0
Occupancy Permit
Permit Date
BUILDING Use
5?-
General
Siding
Type of Construction
Foundation
Size:
-feet wide X
feet long
Square feet area
Height:
Stories and Basement
feet above Grade
Width alLot
No. of Rooms
l
Mason
Carpenter
Architect
I "
1
1-
1- ---1t
Î
I
R.I.
----1t
Inspections -
Footing
Foundation
.3 I Electric Service
"1
'õ
t I Sewer
0
Water Service
Final
Estimated Cost
2?fS- ~
Fees Paid
;?5õ
TO THE BUILDING INSPECTOR: In accordance with Section 7-18 of the Municipal Code of the City of Oshkosh, it is agreed that If work shall be
discontinued for a period of 30 days at anytime lor any cause after excavation work is commenced, a solid barrier, wall, orwire tence not less than
five feet in height shall be erected all around such excavation. Such barrier, wall or wire fence will remain in position until removal is approved by the
Building Inspector. X
In the performance of this work the undersigned agrees to abide by and do work pursuant to all statutes, ordinances,
codes, and rules governing the described construction.
(Signed)
Address ~ Phone
By cT-- Ð. L ~ Agent
(A"'ho""'S;Š,)
Address Phone