HomeMy WebLinkAbout0020932-Plumbing (water heater)
~
CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
20932
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG tS SIGN 0 ZONING FLOOD PLAIN HEIGHT
- - - - - - - - - - - - - - - - - - - - -f:i- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ADDRESS /r.$ --=------ PLAN NO.
OWNER /f..e-. . , s: c ~
DESIGNER
oJ
USE/NATURE OF WORK
R~~~
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATIl\JG 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_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT -'-WH
6.~
_Sh
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_Lav
_ San. Sewer
_Sink
_FDr
_LTub
_Ur
_ Storm Sewer
_WC
_ Eject
_SS
_ Water
Other
wJ~~~!o I~
FEES: Valuation $
ISSUED BY
Permit Fee Paid $
C!~ CP~
'3 t:.('), O()
..;L:-a , e."
J
/
Park Dedication $
Final/O.P. JD~'fo. 1D
Date
/a>//7/?a
/ /
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
'~4 ,~~
I t.t ?> j)kk- d
I"~ /7 - 10
DATE
ADDRESS
').'?lJ-/!iJ(
TELEPHONE #
STATE OF WISCONSIN )
l ) SS
WINNEBAGO COUNTY ~ )
if ~Nam~
Jf17; ~4
(Add res s )
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 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 plum~ing 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.
Dat ed this /7
da y of I 0 . 19 9' ()
jfp~4 ~~
Subscribed and sworn to before me
this !-1-<L'
day of CD~
yf~
PUblic, Winnebago County, Wisconsin
My Commission Expires: Lo ~ /95'.:t
If
19?o
,
.
ADDRESS I V.5 ~ PLUMBING
OWNER I/~ ~ ~ .
NATURE OF WORK fA.J~ ~
PERMIT APPLICATION
DATE /0/,/ s- /90 PERMIT4f
I /
PLUMBER C)~a--.
OJ 6 '7 3ul....
,.
NEW
RELAY
REP AI R
INTERIOR
u
SAN SEW =If :f.b
WATER , Bathtub Catch Basin
STORM SEW Lavatorv Grease Trap
Toilet Sump Pump
INSPECTION DATE INSPECTION DATE Kit. Sink Local Waste
O~-c ~ - Rq~- Sink(other) Site Drain
Shower Laundry Stand Pipe
~Le~&~ Floor Drain Laundry Tray
Disposal Wat. Softner
0 .,~~ Dishwasher D. Fountain
Water Heater Ejector
CO 16 TTrinals Future outlets
c>rl
! V:;Io
t** Violation notes on the reverse side}