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IF Lot
Type of Permit:
Nature of Work
PERMIT - APPLICATION AND RECORD
Block 0 Ward
Building ❑ Electrical FvK Heating ❑ Plumbing ❑
CITY OF OSHKOSH
Owner
Subdivision
Sign ❑
PLUMBING CONTRACTOR
Bu. San. Sewer Curb to Bu. Main to Curb:
Bu. St. Sewer Curb to Bu. Main to Curb
Sewer Fees
Water Service
Bath Tub
Wash Basin
Water Closet
Kit. Sink
Water Heater —
Shower Bath_
Plumbing Fees
Floor Drain
Urinal
Garbage Disp.
S. Sink
Dish Washer
Catch Basin
Laundry Mach.
S. Pump
Water Soft.
B & S Waste
Bubbler
Conductors
Total Fees
HEATING CONTRACTOR
Fuel: Gas ❑ Oil ❑ Elec. ❑ Solar ❑ Solid ❑
Conditioning Forced Air ❑ H. W. El Elec. Base El Steam ❑
System Gravity ❑ Supplementary ❑ Air Cond. ❑
Chimney: "A" ❑ "B" ❑ Direct Vent O Con. Burner ❑
Calculated Heat Loss System BTU Rating
ELECTRIC CONTRACTOR `
Electric Service: New Changes t/� Temp.
Description -Type Volts� -""6 Am
Fixtures Switches Recep's Circ's —
Signs
Zoning
Wrecking ❑ Occupancy Permit A-, Insp
BUILDING Use
General Cont. _
Roof
Foundation
Size:
Height:
feet wide X feet long
Stories and Basement
Width of Lot
t-c .fit.
"i
Siding
Type of Construction
Square feet area
No. of Rooms
MaGnn
N° 6573
Id. No.
Flood Plain
Permit Date
feet above Grade
Carpenter
Architect _
Inspections -
Footing 4ou dation
o Electric Service, Z- ( R. 1.
a
0
.s Sewer Water Service
Q Final
Estimated Cost _�' Fees Paid �!� Date DEC — 2 2 1980
TO THE BUILDING INSPECTOR: In accordance with Section 7 -18 of the Municipal Code of the City of Oshkosh, it is agreed that if work
shall be discontinued for a period of 30 days at any time for any cause after excavation work is commenced, a solid barrier, wall, or wire
fence not less than five feet in height shall be erected all around such excavation. Such barrier, wall or wire fence will remain in position
until removal is approved by the Building Inspector. X
In the performance of this work the undersigned agrees to abide by and do work pursuant to all statutes,
ordinances, codes, and rules governing the described construction.
(Signed) Owner
Add resjs�
(� Agent
By (Authorized srq ature)
Address