HomeMy WebLinkAbout0012025-Plumbing (interior)CITY OF
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Address
PERMIT - APPLICA'11' I /AN AND RECORD CITY OF OSHKOSH
Owner
Lot Block
Type of Permit: Building ❑ Electrical ❑
' Ward Subdivision
Heating ❑ Plumbing Sign ❑ Wrecking ❑ Occupancy Permit
Nature of Work c2Z2Yir &224 01. t-/%" �/
PLUMBING CONTRACTOR C�
Bu. San. Sewer Curb to Bu. Main to Curb:
Bu. St. Sewer Curb to Bu. Main to Curb
Sewer Fees
Water Service
Bath Tub. Floor Drain
Urinal
Wash Basin -:2— Garbage Disp.
S. Sink
Water Closet Dish Washer
Catch Basin
Kit. Sink Laundry Mach.
S. Pump
Water Heater Water Soft.
B & S Waste
Shower Bath Bubbler
Conductors
Plumbing Fees <r
— Total Fees
HEATING CONTRACTOR
Fuel: Gas ❑ Oil ❑ Elec. ❑ Solar ❑ Solid ❑
Conditioning Forced Air ❑ H. W. ❑ Elec. Base ❑ Steam ❑ Radiant ❑
System High Eff. ❑ Supplementary ❑ Air Cond. ❑ Ventilation ❑
Chimney: "A" ❑ "B" ❑ Direct Vent ❑ Con. Burner ❑ Flue Damper & E.I. ❑
Calculated Heat Loss System BTU Rating
ELECTRIC CONTRACTOR
Electric Service: New
Description -Type
Fixtures
Appliances
Switches
Changes
Volts
Recep's
Temp
Amps
Circ's
BUILDING Use
General Cont
Roof
Foundation
Size:
Height:
I
feet wide X feet long
Width of Lot
ft.
Stories and Basement
N_ 12025
Id. No.
Zoning Flood Plain
Insp. ��� Permit Date 6/
Siding
Type of Construction
a°
0
Iv
Q
Square feet area
feet above Grade
No. of Rooms
Mason
Carpenter
Architect —
Inspections -
Footing Foundation
Electric Service R.I
Sewer Water Service
Final . <3'f _K0/1"r
Estimated Cost i Div' Fees Paid Date I�
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, orwire 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 goverr)og the described,,eeVstruction,l
(Signed) �_/_ (�_
r
Address Phone
j Agent
�tPT%u horized Signature)
Electrical Signs I Mi-- --
STATE OF WISCONSIN )
SS
V7INNEBAGO COUNTY )
(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., � o
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 T -7or'„
may be done by one who owns and occupies his own home providinc
the installation complies with the plumbing code of the City a -f
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 19
Subscribed and sworn t before me
this 4 day of 19.
Notary Public, Winneba
County, Wisconsin
My Commis s ion Expi res s & - /2 - L