HomeMy WebLinkAbout0034559-Plumbing (floor drain)/`'~ CITY OF OSHKOSH
PERMIT -APPLICATION AND RECORD
Div
N° 34559
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG [~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~ 6 ~ ''V• l '~N PLAN NO.
OWNER ~ 4~
DESIGNER
BUILDING CONTRACTOR
Size Sq. Ft.
Foundation
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
Heat Loss
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
BTU'S
PLUMBING CONTRACTOR
- 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 $ ~~ a ~
ISSUED BY ~
Permit Fee Paid $ _
Date
/'O.oO
Park Dedication $
G 3 9~ Final/O.P. ~ ~ ~ "~.~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
ADDRESS
HUtN I/V WNtH
c~S~C~, 5
# Rooms # Stories
Class of Const.
Height .
Occupancy Permit
~~ -43
DATE
~/2~-iA 9
TELEPHONE #
STATE OF WISCONSIN )
SS
WINNEHAGO COUNTY )
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 h1m 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 coda 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 afflant 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 `, u rlE 19
Subscribed and sworn begone me ~ U
this ~ day of 19~_.
`""7vi _ . .~ ~ ,
Notary Pu~ic, Winc~iebago County, Wisconsin
My Commission Expires: ' - ~~_
" ~ nvc PEa~sr A~cazzoN
owNSa ~~y Z ~
~Z'D8E OF WCRB ~~:., ~ '
tv~r1 Ant na~x~og
SAN SESJ ~ # #
~JATER Bathtub Su Pu
Lava Ejector
?oiler Water Softener
~ ~~ ~~~~ ~~ ~t• Sink Drinkin Fountain
Siakt otiser
W e ter Slo Sink
~~ 3~ e se a
/ 3 ~ Floor Drain Local Waste
Laundry Tu Site Drain
Dis osal Laundr Stand i e
Dishwasher Catch Basin
** Violation notes oa t3i reverse side