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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
16542
TYPE: BLDG D HTG D ELEC D PLBG 8 SIGN D ZONING
FLOOD PLAIN
HEIGHT
USE/NATURE OF WORK /1e<"A/
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PLAN NO.
ADDRESS
OWNER
DESIGNER
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR /I(J~ ,h-~ ('
-L BT 1 WH _ Disp _ WSoft
LLav ~Sh --!-DW _OF
~ WC .2.... FOr 1 SP _ Ur
-/- Sink L L Tub Eject _ SS
Other 1- I~o/~, )'k;;;'j>c
_ CBasin
_ San. Sewer
_ Storm Sewer
_ Water
FEES, Valuation $J:J..~-
ISSUED BY ~ /n/
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Permit Fee Paid $ 5"";Z ercl
Date //- .22.-?f
Park Dedication $
Final/O.P. I Z .. ;LJ - 8-J'l
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 0<. lJ~~l ~;,~.fl).,
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
NATURE OF
SAN SEW
WATER
STORM SEW
INSPECTION
PLUMBING PERMIT APPLICATION
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WORK A: .A/ ;e:
NEW
RELAY
REPAIR
DATE
INSPECTION
L1 C to/II /~
,(J; /1/3/81 wlffJV!et/c!tfJ1f
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1** Violation notes on reverse sidel
DATE fJ -~Cl - sYf PERMIT if 1t:;~c(..2..
PLUMBER {} ,1f/?Z#1/uf ?
INTERIOR
if
Bathtub
Lavatory
Toile't
DATE Ki t Sink
Sink(other)
Shower
Floor Drain
Disposal
Dishwasher
Wa,t:er' Heater
Urinals
if
Catch Basin
Grease Trap
Sump Pump
Local Waste
Site Drain
Laundry Stand p1pe
Laundry Tray
Wat. Softner
D. Founta1n
Ejector'
Future outlets
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