HomeMy WebLinkAbout0032885-Plumbing (water heater)
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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32885
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N2
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ADDRESS ///6 G--~ PLAN NO.
OWNER T a-~ f ~~
DESIGNER
~~w#
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
HEATING CONTRACTOR
J
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
')
ELECTRIC CONTRACTOR
Electric Servo
New 0 Change 0 Temp 0
Type _ Volts _ Amps ~
Fixtures
Switches
Receptacles
Circuits
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PLUMBING CONTRACTOR
_BT LWH
C>~~-
_WC
_FOr
_ L Tub
_Ur
_ CBasin
_ San. Sewer
_ Storm Sewer
_ Water
~
_ Disp _ WSoft
_Lav
_Sh
_OW
_SP
_OF
_Sink
Other
_ Eject
_SS
FEES: Valuation $
ISSUED BY
3.s-rJ> ,0 <0
~
Permit Fee Paid $
Date
,
;^LJ "". c> C V'
.3 -S~-7'_5
Park Dedication $
Final/O.P. 4-6-q3
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE (); --1/(1 V r d2?::f:i;~~{~f;)
./"'/ r AGENT/OWNER
ADDRESS:/
DATE
TELEPHONE #
STATE OF WISCONSIN )
) ss
WINNEBAGO COUNTY )
/t~f.tf(~<7U , / fiG ~d/1~4
Name . I- ,. Addres
~~ing fizst duly sworn on oath deposes and says that he is not
a licensed plumber, and that he has applied for a plumbing
permit to the Plumbing Inspector of the City of Oshkosh, to do
plumbing work in a home 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 Wisconsin, which provides that all plUmbing work.
must be done by a licensed plumber except that the plUmbing work.
may be done by one who owns and occupies his own home providing
the installation complies with the plumbing code. of the City of
Oshkosh and the State of Wisconsin.
. This affiant understands that the Plumbing work authori~ed
by the pe:mit applied for, must be done only by this affiant. and
that he cannot employ others who are not licensed plum~ers to
assist with the work. ' j)
Dated this ~ day of -:7l! /J..A~ ./ . 19 9 8
/fJ.~~~
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Subscribed and sworn to befo~~:
thi:s ~ I 19 93
.
My Cammission
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~ OF -HEW ~~ ~Ifn( (D. . tmDIOR At ~---- · -
~
SAN SEW # #
W'A'l'Elt BadU:ub Sumn PUIllD
~~ LavatoroT Ejector
Toilet Water Softener
!Nsn~+foN DA~ msncnON DAtE Kit. Sink -- Drinkin g Fountain
:l ~/O SiDk(other) TT...~,..,,,,1
f! S 7 W~terheater Slop Sink
r....e~se Tran
. '-I- S Floor Drain Local Waste
F Laundry Tub Site Drain
Disposal Laundrv Standpine
r Dishwasher Catch Basin
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