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HomeMy WebLinkAbout0025973-Plumbing (water meter)~ CITY OF OSHKOSH N° 25973 `' PERMIT -APPLICATION AND RECORD TYPE: BLDG ^ HTG ^ ELEC ^ PLBG, ~ SIGN ^ ZONING FLOOD PLAIN HEIGHT ADDRESS ~ ~ PLAN NO. OWNER DESIGNER USE/NATURE OF WORK -~~-~~"" BUILDING CONTRACTOR Size Foundation HEATING CONTRACTOR Heat ^ A/C ^ Vent ^ Fuel/System # Rooms # Stories Class of Const. Heat Loss ELECTRIC CONTRACTOR Electric Serv. New ^ Change ^ Temp ^ Type Fixtures Switches Receptacles PLUMBING CONTRACTOR U --~~ BT WH Disp Lav Sh DW WC FDr SP $ink LTub Eject Other WSoft DF Ur SS CBasin -San. Sewer_ -Storm Sewer -Water ~- FEES: Valuation $ ~ S~ Permit Fee Paid $ ~~' ~ ~ Park Dedication $ ISSUED BY ~ .~7`"~'--"`~~~ Date ~'~ ° ~ ~ °S~ Final/O.P. ~~ ~ a ~ ~ ~ ~ In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATUF ADDRESS Sq. Ft. Volts Circuits Height . Occupancy Permit BTU'S Amps ~~ ~ ~ ~ r ~~ DATE ~3~ ~ U~~~ TELEPHONE # STATE OF WISCO~iSIN ) SS WINNEBAGO COiJNTY ) Name - ZAddress ' 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 moat be done by a licensed plumbez 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. Thin 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. jj''°°~~ Dated this ,~ day of yC'~ 19_~. ~: G Subscribed and sworn to before me this ~ day ~of _ 19~. Notary Public, Winnebago County, Wisconsin My Commission Expireas • ,Z~~~ IR~ PLUMING PERMIT APPLICATION ADDRESS ~~~~'. sue-- DAB !© ~ ~ 3 - ~/ PERMIT~~ ~- ~" S 7 -~ OWNER ~~^-~- Q PL ER ~ c-L ~•.~ NATURE OF WORK ~,.r, -~ NEUl RELAY REPAIR INTERIOR S SEW WATER ~ ~ Bathtub batch Basia Lavato Grease Tra SPECT Toilet ~ g p ION DATE INSPECTION DATE % Kit. Sink Local Waste ~ ~ S ~ Z L , Sink other Site Drain Shower Laundry Stand Pipe Floor Drain Lauad Tr ~; ~~ ~// ~ Dis osal Wat. Softner Dishwasher D. Fountain Water Heater E ector Future outlets '""~` he reverse side