HomeMy WebLinkAbout0001427-Plumbing (kitchen sink)
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PLUMBING PERMIT - Oshkosh, Wisconsin ~. Pe"¡"it N<:' 1427 ?t
// - . /1 Name //, /} . Street "'> /1 L? /If' ¿
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l Addition or Replai
[ Lot No.
r Block I Ward
Date
OUTSIDE WORK
NAW SEW" WAtER STORMS FEES fEES RELAY S. SEWER WAtER STORMS feES
From MaIn to Curb Septic Tanks From Main to Curb
F>om Curb to Bulldloll Eleclric Pumps From Curb to BuUdlog
Rapair
INSIDE WORK
110. NEW .... USED flES NO. NEW RE'. USED fEES "O. NEW REP. USED fEES
- - - -
BathTub Garbage Dilpooab Catch Bolns
-
Wub BolD Dilhwohen - Conduclorl
- - - -
Water Cl_t Laundramall Graue Catch Bolns
,12- -
~ SIDk ¡/' Watar Softene.. Sump Pump" Ejeclors
Water Heaten sanUary Bubblers Bar and Soda Wastes
Shower Bathl Urinals
ncor Dr8iDI Denial Cuspidon
Laundry TuhII Service Sinks
Inapecllona Valualion of the Work HerelD Described Fee Verified. Receipled and Recorded Received PermU and Inspeclion F...
-.-m.---....-..-..-m--....mm.............Ouilide $..3C!12...~...m....--mmm--._..........--....--.. .........-......--m--.m.5ower Fees
.--.m.m.--.......--...-..._--__m....._...---.mInaide mm"¿!.f!f:'.--..Plbg. Fees
$.-.........m...--.....m._.....--..m.._m..m... --"m..m.'" ;:¡
___m..---.....--_m..__._.m_._.._--....'-.--'- .m _m------ mmë.'.ïT,...~;ë;...mm._..m...m--. D~~:mm~%~;;/
---_____.m_._--------FiDal OK $mm...--....--m--_mm...--......m.--m_---.....mm_..m.-
In the performence of this work Ihe undersigned owner (or his authorized agent) of said premises and his authorired Plumber hereby agree to be bounden by and
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public W he government of Plumbers.
It Is futher agreed by the undersigned that no other uses will be made of the above connedio s exce t as he~listed.
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STATE OF WISCONSIN)
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WINNEBAGO COUNTY)
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\Name ì
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O(Address
being first duly sworn on oath deposes and says that he is not
a licensedplumÞer. and that he has applied for a plumbing
permit to the Plumbing Inspector of the City of Oshkosh, to do
plumbing work in e ¡\Ome 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 affidavit is made for the purpose of complying with
the provisions of the plumbing code of the City of Oshkosh and
the State of condn, which provides that all plumbing work
must be done a licensed plumber except that the plumbing work
may be done by one ~ho owns and occupies his own home providing
the installation complies with ~he 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 Gan~ot others who are not licensed plumbers to
assist with the,
. P't,d "" ß/~ d,y of ~-
Subscribed and sworn to before me
<hi ~ ~ -iJ~:~ ,~19 ~
Notary pUbt}!;, \1i~ebago County, \Ilis consin
. AlY ~MMISSION £XPJRES
My Commission Expnes :_------:::~~~l~__":':"--