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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
18393
TYPE:
SLOG 0 HTG 0 ELEC 0 PLBG ~ SIGN 0 ZONING - FLOOD PLAIN - HEIGHT-
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DESIGNER 2:
USE/NATURE OF WORK - r;¡.>/1/!A-,ç-A
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BUILDING CONTRACTOR
Size
Foundation
Sq, Ft
# Rooms
# Stories
Height
Occupancy Permit
Class of Cons!'
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuei/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Eiectric Serv,
New 0 Change 0 Temp 0
Type- Voits- Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
ÛÌ-v-YLP/- ..--
+BT
+Lav
+WC
+Sink
Other
_WH
_Sh
_Disp
_OW
_WSoft
_OF
- CBasin
- San, Sewer
_FOr
_SP
_Ur
- Storm Sewer
-I-C1l:lb-
_Eject
_SS
_Water
0'""
FEES: Valuation $ I J7fö
ISSUED BY ~ A---'C~~
Permit Fee Paid $ ~') 117;> ý'
Date 5 -IO--;í7o
Park Dedication $
Final/OP,
In the performance of this work I agree to perform ali work pursuant to rules governing the described construction,
SIGNATURE t7~~ ~~\~~~
, '"GENT/OWNER
DATE
ADDRESS
TELEPHONE #
,.,
WINNEBAGO COUNTY
STATE OF WJ:SCONSIN )
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V-~ (£f4/l~:j
[; SO ~/ f1L
(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 owned 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 affidavj,t 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 done by a licensed plumber except that the plumbing work
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 affiant and
that he cannot employ others who are not licensed plumbers to
assist with the work. '
Dated this ~ day of ~ay
A~~~~ü\,k,
. 19 96
sub~crib~d and sworn to before me
this, \ð~day of ~
~~\h"" "\'" m,,".()Q,,-
~otary P~blic, Winnebago County, Wisconsin
f) Is /qD
, 19 C\.é) .
MÝCommission Expires:
PLUMBING PERMIT APPLICATION
ADDRESS C ~ (A/ ¿/~ DATE ")-9- 7"0
:~E OF WOR::¡:::::!¡r: L &-110 _L :tkj/~~71~--
NEW RELAY REPAIR INTERIOR
PERMITit A?391
~
SAN SEW I I I I it it
WATER T I I I Bathtub Catch Basin
qTORM SEW I , Lavatory Grease Trap
J Toilet Sumn Pumn
INSPECTION DATE INSPECTION DATE "Kit. Sink Local Waste
Sink(other) Site Drain
0 ßyC^<- 5/1!f;ö Shower ! Laundry Stand Pipe
Floor Drain Laundrv Trav
- 57/J/7"ú J t/e~1 ~L ,d h""",v, Disnosal Wat. Softner
~4 Dishwasher D. Fountain
-") Sf'?/ ó// ¡¿r u/{jk Water Heater Ejector
OX J"IY/9ð 3) "'I' LA"",,? n..-inals Future outlets
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1** Violation notes on the reverse sideJ G, 0 -rÞ~ cÍo---c<- ð?-- Kr ~./' ~ < icn~