HomeMy WebLinkAbout0013157-Plumbing (deduct meter) CITY OF OSHKOSH No 13157
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBGA SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / � � / /I {it'd 7 PLAN NO.
OWNER 1z.'1-04/5 e
DESIGNER
USE /NATURE OF WORK Z- `° A , '1.0A Aar■--, 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 ____l�f_ _
BT WH Disp WSoft CBasin
- Lav Sh DW DF San. Sewer
- WC FDr SP Ur Storm Sewer
- Sink LTub Eject SS Water
Other
/ c."-c,
FEES: Valuation $ l Permit Fee Paid $ G C/ Park Dedication $
ISSUED BY ,l - c",--..- -/ Date" 17,--CS Final /O.P.
In the performance of this work I agree to perform all work pur uant to rules governing the described construction.
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SIGNATURE / f
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
STATE of WISCONSIN )
) SS
WINNEBAGO CO ) 166a /
1‘124
(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 'T 1 day of RAY 19 / .
›Zal
- ,14 " ,/e, .
Subscribed and sworn to before me
this wl day of //,il 19 Al
A) a. / 'Jt /
Notary Public, Winnebago County, Wisconsin
My Commission Expires: 3 -:02/-95
APPL. DATE 7` )&O /9J PERMIT ISO. 57 2
ADDRESS / !/'1 h te d
OWNER ,y - .+ ` 5
NATURE OF WORK 1 !•/ bL
HEATING CONTRACTOR
FUEL: GAS OIL COED SOLAR
SOLID
CONDITIONING FORCED AIR H.W
SYSTEM ELEC• BASE. STEAM
RADIANT SUPPL. (Cg/C VENT
CHIMNEY: "A" "B" DIRECT VENT
CALCULATED HEAT LOSS p CON.BURNE
MISC. _SYSTEM BTU RATING
INSP. ROUGH IN
FINAL Agrf
EST. COST dal _ c_ PERMIT FEES ��
„ �
REMARKS �® �� DATE PD !..%1i
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