HomeMy WebLinkAbout0040956-Plumbing
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N!-40956
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG % SIGN 0 ZONING FLOOD PLAIN HEIGHT
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ADDRESS I(;~ PLAN NO.
S c::~o
OWNER
DESIGNER
L Ld
F~ L~Lr m_~_
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
~ HEATING CONTRACTOR
Heat D AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
I'
ELECTRIC CONTRACTOR
Electric Servo New 0 Change 0 Temp 0
Type _ Volts
Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR (!)~
_BT _WH _Disp _ WSoft _ CBasin ~
1Lav LSh _OW _OF _ San. Sewer
~WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
/,;0( ~ C::> C ~ J
FEES: Valuation $ ..J-. 0 C ~ . t'l) d Permit Fee Paid $ Park Dedication $
ISSUED BY #;:/~ Date 2/-S-/:9 Y Final/O.P.
" /
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
~e~
AGENT/OWNER
~- S -'1Lt
DATE
d.3l- 39~
TELEPHONE #
ADDRESS
STATE OF WISCONSIN )
) SS
w:tNNEBAGO COUNTY )
S+u.C\.'\+ ChoJ1oi'\e, I IbS6 1iu..Y\--t~\<; GleV\. ))",
(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 WClrk 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 bome when cOmpleted. That be 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 authorized
t by the permit applied for, must be done only by this affiant and'
. that he cannot employ others who are not licensed plumbers to
f.
t ass ist with the work.
Oat ed this
5
day of A~ lA,.S + . 19 qL{
JXu~J 2:. ~~
.
Subscribed and sworn to before me
this
day of
, 19
.
Nota ry Public:, Winnebago County I Wiscons in
My Commission Expires:
SPEC'nON
0J~r~
ADDIESS
.
~B.
- NA'!'1JB.E OF WOIUt
NEtl
RE1.AY
BEPAIB.
SAN sn'
iJA'I'E:R
I
DA'l'E
msncnON
DAm
Sum Pu
Ejector
Water Softener
Drinkin Fountain
K { - NIT. CJ//7
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** Violation notes on the reverse side~