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PERMIT - APPLICATION AND RECORD CITY OF OSHKOSH N~
3/t¡ /f o~//;, Owner Ly/... [?as¡¡oer Id. No.
Block - Ward- Subdivision Zoning- Parkland Dedication Fee Height Permit Flood Plain
Electrical 0 Heating 0 Plumbing ß- Sign 0 Wrecking 0 Fence 0 Pool 0 Occupancy Permit Required Insp.- <~ Permit Date ~
23095
~
OSHKOSH
Lot
Type of Permit:
Nature of Work
BUILDING Use
General
Siding
Type of Construction
Foundation
Size:
_feet wide X
feet long
Square feet area
PLUMBING CONTRACTOR
Bu. San. Sewer - Curb to Bu.
Bu. St. Sewer Curb to Bu.
Main to Curb:
Main to Curb
Height:
Stories and Basement
above Grade
Width of Lot
No. of Rooms
Sewer Fees
l
Mason
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 Solt. B & S Waste -
Shower Bath ~ Bubbler Conductors
Plumbing Fees Total Fees
Carpenter
Architect
,----".
I
I
--------Ít.
Inspections -
Footing
Foundation
HEATING CONTRACTOR
Fuel: Gas 0 Oil 0 Elec. 0 Solar 0 Solid 0
Conditioning Forced Air 0 H.W. 0 Elec. Base 0 Steam 0 Radiant 0
System High Eft. 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
1
~ I Electric Service
~ Sewer
"
R.!.
Water Service
ELECTRIC CONTRACTOR
Electric Service: New
Description-Type
Fixtures-
Appliances
Changes
Temp.
. Final
Estimated Cost <?nv ~ Fees Paid 2- ÓÒ' Date
TO THE BUILDING INSPECTOR: In accordance with Section 7-18 of the Municipal Code of the City o/Oshkosh. it is agreed that if work shall be
discontinued for a period of 30 days at anytime for anyeause after excavation work is commenced. a solid barrier. wall. or wire fence 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.
Switches
Volts
Recep's
Amps
Circ's
(Signed)
Address Phone
By ~/~ a d17ÞYrIP - Agent
(A~'m",d Sigoo'""1 ' ""-
Electrical Signs
Address
Phone