HomeMy WebLinkAbout0000087-Plumbing (remodel)_CITY OF OSHKOSH No _00087
PERMIT APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC LBG ~ .SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~~ ~ ~ C ~ ~~ / S
OWNER
S
PLAN NO.
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft,
Foundation
# 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 ~ w ~fi Ca ]~
~BT ~!WH _ Disp WSoft _ CBasin
~Lav _ Sh DW _ DF San. Sewer
~WC _ FDr _ SP Ur _ Storm Sewer
~ Sink ~L~-/Jr~ Eject _ SS Water
Other
FEES: Valuation $ ~ ~ G Permit Fee Paid $ , ~~^~ d D Park Dedication $
ISSUED BY ~ Date ~ ~i Final/O. P.
In the pertormance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
+~/OWNER
DATE
ADDRESS
TELEPHONE #
STATE OF WISCONSIN )
} SS
WIDINEBAGO COUNTY )
~a~rQ./l ~zros- s, /G~~ ~e~~~~
Name Address
being first duly sworn on oath deposes and says that he is not
a licensed plumber, and that he has applied fora 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.
Dated this ~_ day of
~ly~ 1.9 ~ b
Subscribed and sworn to before me
this ,~ day of 19 ~ .
4Q,.~ 1i ~~.~~~
Notary Public, Winnebago County, Wisconsin
My Commix s ion Expires a ,~ ~ ly ~ ~ o