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CITY OF OSHKOSH Ng
PERMIT - APPLICATION AND RECORD
01417
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ADDRESS
PLAN NO.
OWNER
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DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATINGCONTRACTOR Ct?ncbn fr/-o/ {77P1?~r}--
~eat ~ NC D Vent D Fuel/System ;r/-G- Heat Loss ~ tph.?U~TU'S
9'~~
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ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
FEES: Valuation $
ISSUED BY
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Permit Fee Paid $
Date
/
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Park Dedication $
Final/O.P. / IA~" -PI:.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE_~
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DATE
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TELEPHONE #
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PERMIT NO. ~d/iI7 APPL. DATE 7#Jl/d
ADDRESS / 3t 0 C7 /'ch a rei k J? ~
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HEATING CONTRACTOR C./~ hl~H ""19 'fa I C~.rn-{drY
FUEL: ~ OIL ELEC. SOLAR SOLID
CONDITION,lNG
SYSTEM
RCED AIR
RADIANT
H.W.
SUPPL.
ELEe. BASE. STEAM
AI C VENT
CHIMNEY: "A"
CALCULATED HEAT LOSS
MISC.
INSP. ROUGH IN
EST. COST~ 1. ? gr~_ ~
REMARKS I
RE T VENT CON. BURNER
SYSTEM BTU RATING 9tf! ~
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