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CITY OF OSHKOSH
N °_44316
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG) SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS r' ti PLAN NO.
OWNER W a2-
DESIGNER /� 1__„,____/
USE/NATURE OF WORK ` ^ � ,,
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ NC ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
- BT _ WH _ Disp — WSoft _ CBasin
j _ Lav _ Sh _ DW _ DF _ San. Sewer
WC _ FDr __SP _ Ur — Storm Sewer
Sink _ LTub _ Eject _ SS __Water
Other
FEES: Valuation $ • /65 • ®'® Permit Fee /� 0 1 . 0� ✓
ee Paid $ ./ Park Dedication $
ISSUED BY Date �s' j �S Final /O.P
In the performan of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATU 1 / /L.. - -I. B/30
49S
T /OWNER DA
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ADDRESS oZIO y/
TELEPHONE 41
STATE OF WISCONSIN )
) SS
WINNEBAGO COUNTY )
i a e_ (e h r, 1(); t r �G► s
(Na (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 SO day of / . 19 45 . •
A
Subscribed and sworn to before me
this day of , 19
Notary Public, Winnebago County, Wisconsin
My Commission Expires:
Plumbing Permit Work Card
Job Address 3101 BELLFIELD DR Permit Number 0000000 7,6 Create Date 03/30/95
Owner BRUCE J /LYNN VOSS Contractor HOMEOWNER
'gory 410 - Residential- Interior Plan Value $510.00
..ntub 1 Shower 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 Ice 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. Hand Sink Urinal
Use /Nature
of Work
FINISH LOWER LEVEL BATH
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Date Type Inspector Approved
Q-. i - N 4 - 71 /..:r/7 I
K t ,'4/2 6--/9-
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