HomeMy WebLinkAbout0012966-Plumbing (interior alterations) CITY OF OSHKOSH No 12966
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG4 SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /� 1 PLAN NO
OWNER Jc= s c 7 ;
DESIGNER
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USE /NATURE OF WORK - 4 Arai / 4 /i ,,,,[.. 1► .�, r / per
. ` i sip �� .- it - _ __- ,/ ■ -
k I h: s"-/-1A : - 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 _ ____6ZL `P_ ___
BT WH Disp WSoft CBasin
L av Sh DW DF San. Sewer
L WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other crezt___/
FEES: Valuation $ Jo P -rmit Fee Paid $ Park Dedication $
/ J
/
ISSUED BY L_ .. Date 1/4c* C Final /O.P. (0 - - 90
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE .` c
AGENT /OWNER DATE '/[ /
ADDRESS 3( -4 7ST7
TELEPHONE #
STATE OF WISCONSIN )
SS
WINNEBAGO COUNTY )
Te- v e \ / l a c ,( c 6 jv\ 1 0 vtes04 �-(. . •
(Na). me (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 C -IL3 day of . 19 .
r�— 1
Subscribed and sworn to before m
this a c Yll ' -- , day of ,u .0 19 P .
S
Notary Public, Winnebago County, Wisconsin
My Commission Expires: 44ao
PLUMS N PERMIT APPLICA N �p
ADDRESS / 3 04 /� -✓ 5K7& DATE Y7�� /-f 7 PERMIT# /.2Fb / d /
- r. OWNER 3 P_ Mr' PLUMBER 62.0"2 V
NATURE OF WORK /15k/Li ,�
NEW RELAY REPAIR INTERIOR
SAN SEW # #
WATER ' i Bathtub Catch Basin
STORM SEW _ Lavatory Grease Trap
3 Toilet I Sump Pump
INSPECTION DATE INSPECTION DATE ( Kit. Sink Local Waste
Sink(other) Site Drain
rf, f s /I // � - Shower Laundry Stand Pipe
7,', ur Floor Drain Laundry Trap
JCL'- ��9�� Disposal Wat. Softner
Dishwasher D. Fountain
,P r `/ .q /i„,/,.. ,"' Water Heater Ejector
Urinals ( Future outlets
r thlq,
I** Violation notes on the yeverse side]
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