HomeMy WebLinkAbout0004437-Plumbing (addition) 1 CITY OF OSHKOSH N2 04437
J PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG X SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS V3 w ri,;/JS o r PLAN NO. es OWNER o I t, A rv0 Z /0 c 4
DESIGNER
USE /NATURE OF WORK HAD /V t u' 4J a 2 /n- SS /4 ,C
A d t/ V
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 0 0 //6 r
BT WH Disp WSoft CBasin
0 Lav Sh DW DF San. Sewer
a WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation /1 0 D Permit Fee Paid g. o o V Park Dedication
ISSUED BY 1 Date Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 1)t eA laic OM 1 r D
AlRRIPOWNER
DATE
ADDRESS
TELEPHONE
STATE of WISCONSIN
SS
WINNEBAGO COUNTY
R O t e, ,r ,7O f4! a C k 9Y•1
(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.
Dated this g day of �I y 19 a
1266.4 P. <46-10-cJk:
Subscribed and sworn to before me
this O day of Cq 19 67
AaWA
Notary Public, Winnebago County, Wisconsin
My Commission Expires: /-5/tYtO