HomeMy WebLinkAbout0048247-Plumbing V/•
CITY OF OSHKOSH N 48247
(■ii) P ERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG 135 SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 4 2 7 v Cil i M,�
PLAN NO.
OWNER
DESIGNER
j
USE/NATURE OF WORK Z-A-
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 C)
BT WH Disp WSoft CBasin C.
1 Lav _L Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation d O Permit Fee Paid a a
Park Dedication
ISSUED BY Date 5 7 Final /O.P. n 4 a7 L9
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 4146 &4 v q X c `i /y f 1
AGENT /OWNER DATE
ADDRESS t I �p2 ij 7 7.1
TELEPHONE
STATE of WISCONSIN
SS
WINNEBAGO COUNTY
(Name). (Address) y
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. 1_
Dated this 1 h day of n P r� C)e
/4(')?1 1
Subscribed and sworn to before me
this day of 19
Notary Public, Winnebago County, Wisconsin
My Commission Expires:
Plumbing Permit Work Card
Job Address 1292 WHEATFIELD WAY Permit Number —coneee- '7 2o2 4 7 Create Date 10/16/95
Owner ED DAWN BURGOYNE Contractor HOMEOWNER
qtegory 410 Residential-Interior Plan Value 6. 00 IfIlltr
_.thtub Shower it Ejector/Grind Dip Well F Prep Sink Grease Trap
Whirlpool Floor Drain Water Softner Drink Ftn Sery Sink Receptor
Lavatory 1 Lndry Tray Local Waste Wait. St. Shamp Sink Other
Toilet 1 Lndry Stndp Clothes Wshr lc. Chest. Flr/Wst Sink
Res. Sink Disposal Bidet Exam Sink Catch Basin
Bar Sink Dishwasher Beer Tap/Soda Sculry Sink Wash Ftn
Water Heater Sump Pump Dent. Oper. Ham! Sink Urinal
Use/Nature
of Work
FINISH LOWER LEVEL BATHROOM
Size Material Type Conn.Type
Sanitary Sewer
Storm Sewer
...der Service
Date Type Inspector L Approved
RI f P- /S
5
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