HomeMy WebLinkAbout1986-Plumbing (deduct meter)CITY OF OSHKOSH Ng 02180
'~' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG ~, SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS
OWNER
# Stories
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
l/ Y
# Rooms
Class of Const.
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type Volts
Fixtures Switches Receptacles
PLAN NO
Height _
Occupancy Permit
Amps
Circuits
BTU'S
PLUMBING CONTRACTOR r~~
BT _ WH Disp WSoft CBasin
Lav _ Sh DW _ DF -San. Sewer
- WC FDr SP Ur -Storm Sewer
-Sink _ LTub Eject SS -Water
Other
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FEES: Valuation $ Permit Fee Paid $ J Park Dedication $
ISSUED BY Date ~ ~ Final/O. P. ~~~~-
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER DATE
ADDRESS
TELEPHONE #
STATE of wlscowslN
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wnarrE~ito coa~TSt ) ,
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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 fs made for the purpose of complying with
the pmvis Iona of the plumbing .code of the .City of Oshkosh and
the State of Wisconsa, which provides that all-.plumbing work
must be done by a licensed plumber except that the plumbing wor!c
may be done by one who owns and occupies his .own hccae prvv+ding
the inatallatioA complies with the plumbing code of the City of
Oshkosh and the .State of Wiscons in .
This affiaat 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 ,,~1,yL day of ~i~rn.~1~ ~?R ,~.
~~.~.~.• 19 •
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_ss2~~~~~, ..
Subscribed and sworn to before me ~ ~`~
`~~
this day of _, 19~~.
____-
Notary Public, Winnebago County, Wisconsin°.
My Commission Expires: 8"/5 ~~Q
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