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CITY OF OSHKOSH N 36189
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG Ki SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /0.26 r v PLAN NO.
OWNER r l
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DESIGNER
USE /NATURE OF WORK F L --4-----/
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR v
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
/S .0
do o ®d
FEES: Valuation Permit Fee Paid g Park Dedication
ISSUED BY Date i/ 7 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
p7--„,22-
AGENT /OWNER DATE
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ADDRESS /aG 7 c' 4 ✓44 9 42GrJ/1 r ooe 44.: r o�3l-v?7
TELEPHONE
STATE of WISCONSIN
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WINNEBAGO COUNTY
Scot? G 1 41 r
(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 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 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. 2
Dated this C;19 day of SE 19 3
Subscribed and sworn to before me
this day of P 19
L /2z11 0(
i
Notary lic, Winnebag County, Wisconsin
My Commission Expires: 9?
PL'1'�ING PERMIT APPLICATION
ADDRESS, f -z t 9 A DATE �S'� PERMIT# 3 9
s
a
OWNER C ii.� I
NATURE OF WORK l Z Z
NEW RELAY REPAIR INIERIO
SAN SEW
WATER Bathtub Sump Pump
Ill ∎Y A. 1 Laysto E ector
I Toilet Water Softener
INSPECTION DATE INSPECTION DATE Kit. Sink r Drinkin a Fountain
1 Sink(other) 6 f( Urinal
&I q 3 D Waterheater Slop Sink
��1 Shower Grease Trap
,Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
,,Dishwasher Catch Basin
Violation notes on the reverse side(