HomeMy WebLinkAbout0000936-Plumbing
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
00936
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG.J&l SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
DESIGNER
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PLAN NO.
ADDRESS
OWNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING 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
6J~'CA..
_Sink
_FDr
_LTub
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_BT
-L Lav
~WC
_WH
-LSh
_ San. Sewer
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
Other
.FEES' Valuation $~ - /
ISSUED BY 7' ~
/
~~l
Permit Fee Paid $ ~
Date ;?' ;/~,h
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 ~~~ ~~
A N WNER
ADDRESS~~~O ~ ~.
'b-\~-~~
DATE
'4;\'\ - ~J~ - ~4-..\O
TELEPHONE # (\....::::.0'(' ~ '
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STATE OF WISCONSIN )
) SS
WINNEBAGO COUNTY )
<O~ R. ~ ~;....~ .~'\-~~ ~ ~.
(Name).~..t. r~ . (Address)
being first duly swo~ 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 it) a, home owned and occupied by him,. or a home
that is being constructed that is owned by him, and which will
beoceupied 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 p1:Ovisions of the plumbing code of the City of Oshkosh and
the state of Wisc:onsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
maybe done by one who owns and occupies his own home providing
the installation complies with the plumbing c.ode. 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.
Dated this \~~
day of
~
~.-:~
. 19 <6 ~
.
Subscribed and sworn to, ~efore me
'. . ~'.i:,.\.,;,<~.
this. J.). 't!J-'dayof . ~~'!t"".,,19 g~
(1h 00'" L r. rf\Q~AM~ . ." . .
Nota ry Public, vl1nnebago County, Wiscons in'
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My Commission Expires:
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