HomeMy WebLinkAbout0012919-Plumbing
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
12919
TYPE:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
BLDG 0 HTG 0 ELEC 0 PLBG~ SIGN 0 ZONING - FLOOD PLAIN- HEIGHT-
OWNER
E:/? ,Ifr:~ r;cS'¿-1
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PLAN NO,
ADDRESS
DESIGNER
USE/NATURE OF WORK fi 1/1 ~~J.
,/61 ~/f'A-- k~/e /¡c9r# ~/ (kÞU~~!J
BUILDING CONTRACTOR
Size
Sq, Ft
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Ciass of Const
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Eiectric Serv,
Fixtures
New 0 Change 0 Temp 0
Type- Volts- Amps-
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
fBT
+Lav
+WC
_Sink
8ÞvrJ? ~
_WH
_Sh
_Disp
_OW
_WSoft
_OF
- CBasin
- San, Sewer
_FOr
_LTub
_SP
_Ur
- Storm Sewer
_Eject
_SS
_Water
Other
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FEES: Valuation $ t<J7V . Permit Fee Paid $ -
ISSUED BY ~G"~ Date -1':ho.k;t'
Park Dedication $
Final/O.P,
In the performance of this work I agree to perform all work pursuant to ruies governing the described construction,
SIGNATUR~ ,~~~~
.2-33~;L7¿) :3
Yþ47
, I DATE
ADDRESS
TELEPHONE #
STATE OF W:¡;SCONSIN
WINNEBAGO COUNTY
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Ron ß/"þ1 ~ ¡fX!? ~('.es r;; V S T-
(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 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 affidav-1t is made for the purpose of complyinc; 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 prov-1ding
the installation complies with the plumbing code of the City of
Oshkosh and the State of Wisconsin.
This affiant understands that the Plumbing \ Ork 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 ..2:!2.- day Of?~ . . 19 pj .
~/~~.
Subscribed and sworn to before me
this -:10.¡ß day f , 19.QL.
Notary blic, Winnebago County, Wisconsin
My Commission Expires:r ';: 199~