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OSHKOSH
Lot
PERMIT - APPLICATION AND RECORD
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Block - Ward- Subdi ision
Building 0 Electrical 0 Heating 0 Plumbing ~ign 0
CITY OF OSHKOSH
Owner ¡)~tX' £//e-~ 1Í1/-....
Zoning- Parkland Dedication Fee
Wrecking 0 Fence 0 Pool 0 Occupancy Permit Required
Address
Type of Permit:
Nature of Work
PLUMBING CONTRACTOR
Bu. San. Sewer - Curb to Bu.
Bu. St. Sewer Curb to Bu.
Main to Curb:
Main to Curb
Sewer Fees
Water Service
Bath Tub 2.. Floor Drain ( Urinal
Wash Basin ~ Garbage Disp. L- S. Sink
Water Closet ~ Dish Washer ~ Catch Basin
Kit. Sink . I Laundry Mach. -i- S. Pump -
Water Heater ~ Water Soft. -- B & S Waste -
Shower Bath ~ Bubbler Conductors
Plumbing Fees (1 C3"- d ()ð 4,", f,A/-< , Total Fees
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HEATING CONTRACTOR
Fuel: Gas 0 Oil 0 Elec. 0 Solar 0 Solid 0
Conditioning Forced Air 0 H.W.D 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.I. 0
Calculated Heat Loss System BTU Rating
ELECTRIC CONTRACTOR
Electric Service: New
Description-Type
Flxtures-
Appliances
Changes
Temp.
Volts
Recep's
Amps
Circ's
Switches
Electrical Signs
N~
21137
Heig~it
Insp. ~
Id. No.
Flood Plain,
Permit Date i~r
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BUILDING Use
General
Siding
Type of Construction
Foundation
Size:
Square feet area
_feet wide X
feet long
Height:
feet above Grade
Stories and Basement
Width ofLot
No. of Rooms
Mason -
Carpenter
Architect
Inspections -
Footing Foundation
~ I Electric Service R.I.
í Sewer Water Service
Q
Final
I
I ft.
,
-
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Estimated Cost ?, c:; 1ST) Fees Paid .-
TO THE BUILDING INSPECTOR, In accordance with Section 7.18 of the Municipal Code of the City of Oshkosh, it is agreed th~t if work shall be
discontinued for a period of30 days al any lime for any cause after excavation work is commenced. a solid barrier. wall. orwire fence not less than
five feel in height shall be erecled all around suchexcavalion. Such barrier, wall or wire fence will remain in position until removal is approved by the
Building Inspeclor. 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)
By
Address
.owner
Phone
Agent
Phone
'IUMa..
CaA/i
¡¿- j,
HAME 01 OWN'.
Bath Tub
Wash Basin
V;ater Closet
Sink
Water Heaters
Shower Baths
F1MrDrains
Laundry Tubs
Garba"" Dis"osals
Dishwash~rs
Laundramats
Water Softeners
Sanitary Bubblers
Urinals
Dental Cu""idors
Service Sinks
Catch Basins
Conductors
Grease Catch Basins
Sllmn Puma & Ej..,tors
Bar and Soda Wastes
RanEe BoHers
Future Outlets
HEW 1t!P.
£nJ¡~
H-
From Main to Curb
!romC'!!'b to Bldg.
a.t..
From Main to Curb
Frnm Cur" ,to Bldg.
1!eDair -
DAtE
I, STom ... HUM'"
S. s.- W....
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Remarks //lb-.. J -/':'-'7
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Inspeolions
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