HomeMy WebLinkAbout0033633-Bathtub & Water Heater
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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33633
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N2
ADDRESS
SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
TYPE: BLOG 0 HTG 0 ELEC 0 PLBG
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PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
~~
~-r +- tAJ H
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
>
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
I
Heat Loss
BTU'S
~
..x
ELECTRIC CONTRACTOR
cA'
"
Electric Serv.
New 0 Change 0 Temp 0
Type_ Volts_ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR ()~
iBT --L 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 $ ..s-O o. (') eJ Permit Fee Paid $ /'0 . 0 ~ { Park Dedication $
ISSUED BY ~ Date V-.2-7 -'/.::5 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE~k
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ENT/OWNER
[-lu1O SoAP
ADDRESS
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DATE
d- ~~- 5100
TELEPHONE #
STATE OF WISCONSIN )
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WINNEBAGO COUNTY )
'I.
/'1ksf1\ ~fP~4t</' I ~10- l~p~
(Name). (Address)
being first 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 eonstructed 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 plumbirigwork
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 authorized
by the permit applied for, must be done only by this affiant and
that he cannot employ others who are not licensed plumbers to
assist with the work.
. "
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Dat ed this
;t-1 day of
VM7f .ifj2:. ~
SUbscribed and sworn to before me.
Ml/'fL
19 {') .
Winnebago County, Wis~onsin
My Col!l!!l1uion Expires: ~::1' 1,((;(,
/
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SAN S:Etl # #
'iAn:ll I Ba.ch cub Sunm PUIllD
~m LavaeOrT Ej ector
Toilee Water Softener
'I:NsncnoN DAn: msncnON DAn: fie. Sink DrinkinQ Fountain
'.#(~. ~P?/I!;;3 /&~' /D J!1~ Sink(oche~) n"';"!:Il
/ W".terheater Slop Sink
Grease Tran
Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standoioe
Dishwasher Catch Basin
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CWNElt
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REPAIIl nn.'Znol.
** Violat:ion not:e~ on !:he nverse sidej,