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PERMIT - APPLICATION AND RECORD
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Block Ward
ElectricalD Heating 0 Plumbing~
Lot
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 Floor Drain Urinal
Wash Basin - Garbage Disp. - S. Sink
Water Closet - Dish Washer - Catch Basin
Kit. Sink ( Laundry Mach. - S. Pump -
Water Heater - Water Soft. B & S Waste -
Shower Bath - Bubbler Conductors
Plumbing Fees Total Fees
CITY OF OSHKOSH
Owner
Subdivision
Sign 0
.:< ' 67>
HEATING CONTRACTOR
Fuel: Gas 0 OilD Elec. 0 Solar 0 Solid 0
Conditioning Forced Air 0 HW. 0 Elec. Base 0 Steam 0 Radiant 0
System High Elf. 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
Eiectric Service: New
Description-Type
Fixtures-
Appliances
Changes
Temp.
Switches
Volts
Recep's
Electrical Signs
Amps
Circ's
&'74Æ <=
N~
15356
Zoning ~
Insp. -
Ide No.
Flood Plain -
Permit Date...zk~
Wrecking 0
Occupancy Permit
BUILDING Use
~
General
Siding
Type of Construction
Foundation
Size:
_feet wide X
.feet long
Square feet area
Height:
Stories and Basement
feet above Grade
Width of Lot
No. of Rooms
l
Mason
Carpenter
Architect
-----1t
l
1
----1t.
Inspections -
Footing
Foundation
.§ I Electric Service
R.I.
1
i I Sewer
Õ
Water Service
Final
Estimated Cost ~ ¿;-v-.::J Fees Paid -<, ~ V Date -<./C /~
TO THE BUILDING INSPECTOR: In accordance with Section 7-18 of the Municipal Code of the City of Oshkosh, it is agreed that it work shall be
discontinued for a period of 30 days at any time for any cause after excavation work is commenced, a solid barrier, wall, orwire fence not less than
five feet in height shall be erected all around such excavation. Such barrier, wall orwire fence will remain in position until removal is approved by the
Building Inspector.
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 ~ p.) Agent
Address Phone