HomeMy WebLinkAbout0026969-Plumbing (remodel)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
26969
TYPE: BLDG D HTG D ELEC D PLBG;tS SIGN D ZONING
FLOOD PLAIN
HEIGHT
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USE/NATURE OF WORK
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PLAN NO.
ADDRESS
OWNER
DESIGNER
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
HE'lat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
1l l\.
ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp D
,
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
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PLUMBING CONTRACTOR
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'?- Lav -L Sh
11- WC _ FOr
~Sink
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-'- Disp
_OW
_SP
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_ WSoft
_ CBasin
_OF
_ San. Sewer
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_ Storm Sewer
Other
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_ Water
ISSUED BY
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<.J ~ 0 u Permit Fee Paid $
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Date
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Park Dedication $
Final/O.P. '1. \ q, \ ,,~
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FEES: Valuation $
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE'-I~."
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, AGENT! ER
STATE OF WISCONSIN )
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WINNEBAGO COUNTY )
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J( e 1/\/ 1l'11 n e 1T 7/' /J1T I/eff7dYl
/' (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 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 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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Dated this I J day of
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SUbscribed and sworn
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this 13> day of
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to befo re me
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Notary l>+1c, W1Dnel:lag~y, Wi.Sco.ndO
My Commission Expires: ~:J J99~ .
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