HomeMy WebLinkAbout0024637-Plumbing (connect city water)P _CITY OF OSHKOSH N° 24637
ERMIT APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG ~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~ c
PLAN NO.
OWNER
DES
USE/NATURE OF WORK ~d~~~ ~J ~ C~c~
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories Height
Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles
Volts Amps
Circuits
PLUMBING CONTRACTOR .--~.t-~-
- BT - WH - Disp - WSoft - CBasin
- Lav - Sh - DW - DF -San. Sewer
- WC - FDr - SP - Ur -Storm Sewer
-Sink - LTub -Eject - SS -Water
Other
FEES: Valuation $ 3 O ~ • O O Permit Fee Paid $
~ ~~ • ~ C7 Park Dedication $
ISSUED BY ~ L~~~ Date ~ ' / '- 9
/
_ ; Final/O. P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ,~l~y,9-1,~ ~~ ~9~
~+ ~~ ~ AOtNT/(jWNER DATE
ADDRESS ~X 9 ~~ wOolD ~/~ U~~~~~`~-~~~.. ~.~~ J!J'~lD
TELEPHONE #
sTATE o~ wlscaNSnv )
ss
wINNEBAGO couNTY )
Na a --r~ (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 plyinbing 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.
Dated this _~_,__ day of ~ v~ lg~.
Subscribed and sworn to before me
this ~_r.____.. day f ~ lg~~.
Notary b ic, Winnebago ounty, Wisconsin
My Commission Expires s ''~ 1..
3 y~
OWNER _L7~L`-~z-,^„ r ~.c,~2c.-,-ccsc
NATURE OF WORK C~-e-~( ~+ G
NETT RRT.~V RFp~TR
PERMIT APPLICATION t~//
DATE ~~~'~ ~~ PERMIT#'Z 7"~ ~ 7
._ PLUMBER ~-~--y~--~
~ .!:~ u--e-` ~--
TNTFRTl1R
SAN SEW ~ ~
WATER Bathtub Catch Basin
Lavato Grease Tra
Toilet I S P
NSPEC ON DATE INSPECTION DATE Rit. Sink Local Waste
_ Sink other Site Drain
C9` ~ ' ~ Shower Laundrq Stand Pipe
~/ ~ ~ ~ Floor Drain Laund Tra
Dis osal Wat. Softaer
t~' -1 .~ Dishwasher D. Fountain
Water Heater Effector
Future outlets
~/ ~0?.5 3~1 f.
** V' on the reve se side f~