HomeMy WebLinkAbout1993-Plumbing~l~
CITY OF OSHKOSH N° 33173
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG ~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS °~°Z!S' /'~'/ cZ ~,~ ~ ~~I - ._
OWNER ^~J ~ -~'
DESIGNER
USE/NATURE OF WORK
PLAN NO
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms # Stories
Class of Const.
Height
Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type Volts
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR Q
-BT -WH
Lav ~ Sh
WC - FDr
-Sink - LTub
Other
Amps
.- Disp - WSoft - CBasin
- DW - DF -San. Sewer
- SP - Ur -Storm Sewer
-Eject - SS -Water
FEES: Valuation $ ~ ~~' ®• e ~ Permit Fee Paid $ ~ ~ • o 0
Park Dedication $
ISSUED BY ~ ~ - ~ ~
Date 9~ Final/O.P. ~ - ~~ ~ ~5~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
ADDRESS /.~ l
A(itN I /OWNER
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DAT
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TELEPHONE N
STATE OF wtsCC)NSIN )
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me 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 axle.
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 ail 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 ~~ G-r-~~, i. lg ~_.
Subscribed and sworn to befor me
this ~a s~ day f i99~
~_
Notary blic, Winnebago County, Wisconsin
My ComR+js s ion Expi rea : ~. I ~ 9 b
ADDRESS ~"'~~~~
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l~L~Z ~~ ~~i~~
S ~ #
~JA R Bath Su Pu
STQ~EW Lavat E'ector
Water Softener
~~~~ ~~ ~t• S].nk Drinkin Fountain
`
. Sisk other
J(~ ~ ~ ~~ ~ ~~ ~
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/ W to Slo Sink
f e T a
Z ~ a' Floo Drain Local Waste
/ Laundry Tu Site Drain
Dis osal Laundr Stand i e
Dishwasher Catch Basin
** Viol=tion notes on the reverse side