HomeMy WebLinkAbout1992-Plumbing (deduct meter)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
28296
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG rj( SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
,
OWNER
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PLAN NO.
ADDRESS
USE/NATURE OF WORK
:L
DESIGNER
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Foundation
Class of Const.
I
Occupancy Permit
HEAriNG CONTRACTOR
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_
Ji
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
~~
_Lav
_WH
_Sh
_ Disp _ WSoft
_ CBasin
~
_BT
_Sink
Other
_FOr
_ L Tub
_OW
_SP
_OF
_ San. Sewer
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
FEES: Valuation $
ISSUED BY
/C>o~ 0 d
CAJ/C-
Permit Fee Paid $
Date
I
....v . 0 b V . .
Park Dedication $.
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
ADDRESS
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TELEPHONE #
SIGNATURE
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Oll'-sso~
AGENT/OWNER
STATE OF WISCONSIN )
) ss
wntNEBAGO COUNTY )
((&vA.) If OJ.!lSStJ"u I g(li.( P/E~CE j\IJ{, \ DSl-/Ko&-H; t1.)J
(Name). (Address) ,
being first duly sworn on oath deposes and says that he is not
a licensed plumber, and that he has appliE!d for a plumbing
permit to the Plumbinq Inspe~tor 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 sal6i.
This affidavit is made for the purpose of complying with
the proviSions of the plumbinq eodeof 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 nis own home providing
the installation complies with the plumbinqc:ode of the City of
Oshkosh and the state of Wisconsin.
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This affiant understands that the P14mbing work authorized
by the permit applied for, must be done o~ly by this affiant and
that he cannot employ others who are not licensed plumbers to
assist with the work.
Dat ad this
2.9 d day of
~
h
before me
. 19
,;.-
.
~
SUbscribe~ and sworn to
(;(l..
this :?9~
l
day of ~l.jJ
cn"~
, 19 J}2~ .
..
Winnebago CountYI Wisconsin
E:xpires: ~ 3' )? 7'..>-
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My Commission
METER(S) PERMIT
Date
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Meter Installed At
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Name of Owner
Address of Owner
Meter(s) Size
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Meter(s) Use
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('Diagram of Use)
Meter will be
installed and used according
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to the above information,
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Owner or Agent
To Water Utility: Requirements have been met to purchase and
install meter(s) at the above address for size and use indicated.
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Plumbing Inspector
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