HomeMy WebLinkAbout0009901-Plumbing (correct violations) CITY OF OSHKOSH N9 09901
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBGG 'SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 2 SZIA 1 /�• PLAN NO.
OWNER ti -- , c . (.
DESIGNER / /
USE /NATURE OF WORK /1-L- ! CA A �!� � <�L1a ,t,..., . e //
MEW
-
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 237'-..e...0
BT WH Disp WSoft CBasin
Lav Sh _ DW DF San. Sewer
— WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other r / - f-jfl_
/
FEES: Valuation $Xcc25 .r1 0C/fr
Permit Fee Paid $ Park Dedication $
ISSUED BY �/ Date Final /O.P.
In the performance of this wor agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ► ` % �� —84— lG
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
STATE OP WISCONSIN )
SS
WINNEBAGO COUNTY )
7Z/ acf
,67r� Z72 ..S'f� /7ewa7/o �2
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 , 1.9 P - ? --- .
V 1-----------
Subscribed and sworn to bef re me
this /6 , day o O: f: , ' 19 �S 6 . Notary blic, W nnebago County, Wisconsin
My Commission Expires:
2 ---
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