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CITY O.F OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02381
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BLDG 0 HTG 0 ELEC 0 PLBG ~~N 0 ZONING
FLOOD PLAIN
HEIGHT
TYPE:
""
,
,
- - - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
,
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ADDRESS
~07;;;'
h/;/I~hJ
OWNER
I!r; f 01' Y
. I
I) d- t .S' C1
PLAN NO.
DESIGNER
USE/N:TtE .o-iWORK g: I",:, .~
f ~ I tv r ,. ~
1 !;;:;-~
LV ~.f ~
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BUILDING CONTRACTOR
Size
Sq. Ft.
Foundation
# Rooms
'# Stories
Class of Const1
Height
Occupancy Permit
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss'
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
Type_ Volts_ Amps~
Fixtures
Switches
New 0 Change 0 Temp 0
Receptacles
, Circuits
PLUMBING CONTRACTOR
(t) w ;t/~, ,--
_BT
_WH
_Sh
_Lav
_WC
_FOr
_ L Tub
h) ~t-Q...V-
_Sink
Other
_ Disp _ WSoft
_OW _OF
_SP _Ur
_ Eject _ SS
,It ~ tr-'f 6j"T;b~
_ CBasin
_ San. Sewer
_ Storm Sewer
_ Water
ISSUED BY
Permit Fee Paid $ .2) . 0 0 t./""
Date /~ //s;/y ~
/
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
~~&~
. AGENT/OWNER
ADDRESS
DATE
TELEPHONE #
."L'
.,
STATE OF WISCONSIN )
) S5
WINNP;:aAGO CO'ON'I'Y )
kilL L/~Nl . .lYws~
Name).'
I
2072 {tCk'f~Y
. .. (A dress
'l..A;Nb
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 Ci#y of Oshkosh, to do
plumbing work: in a home owned and oceup1ed 'by him, or a home ..
that is being constructed that is owned by him, and which Will
be occ:upied by him as his home when completed. Tha t he is not
building said home. for the purpose of sale~
'l'lU.s affidaVit :f.s made fo:e the purposEt of complyinq with
the prc'Visions of the pJ.umbingcodE! ofthe!City of Oshkosh ~nd
the Sta~e of Wisconsin, which provtdes tha~ all plumbing work
must be aone by a licensed plumber except. that the plumbing work
may be done by one who owns ana. occupies his own hpme providitlg
the insta llationcomplies' .with the.plumbinq code of the City of
Oshkosh and 1:he State of Wisconsin. ..
This affiant. understands that. the Plu~bingwcrl< authorized
by the permit applied for,. must be aone on~y by this. affiiant and
that he canno1: employ others who are not l~censed plumbers to
assist ~th the work.
Dated this IS day of /)J:r>: ...... 19R" 10 .
. ~....
SUbscribed and sworn to before me
thIs
/5~day of
-Q .'-V
_ .~ ),Q~ ~ .". ~&az
Q C~ -/
, 19
820.
Nota:Yilublic, Winnebago County, Wisconsin.
g/s- /96
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