HomeMy WebLinkAbout0043351-Plumbing CITY OF OSHKOSH N ° - 43351
PERMIT -- APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLB1 SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 • 3 _, PLAN NO.
OWNER
( ,, /1 / r
f
DESIGNER
USE/NATURE OF WORK ` L . £ . .4r-
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 /
_ BT _ WH _ Disp _ WSoft — CBasin
1 Lav Sh _ DW _ DF — San. Sewer
. WC _ FDr _ SP _ Ur — Storm Sewer
— Sink _ LTub _ Eject _ SS — Water
Other
/ aC 07,E i
FEES: Valuation $ Permit Fee Paid $ Park Dedication $
ISSUED BY */ Date VV Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 42,1...ti_s_.1�� f I
AGENT /OWNER '/ DATE
ADDRESS 3 f (3 Y c Il f/ c74 Or/ //e 1-46 - rf r.1
TELEPHONE
STATE OP WISCONSIN )
) SS
WINNEBAGO COUNTY )
\\ 2K �-- 311 ee /�'� /r Or,
(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 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 r day of e +n (4.a V y . 19 x'37 .
F -4 1
Subscribed and sworn to before me
this day of , 19
•
Notary Public, Winnebago County, Wisconsin
My Commission Expires: •
/�� . tAPZNC PERMIT APPLICATION
ADDRESS // -' � �...a„y V S
DATE . V l� S
OWNER ' %. V / /-¢ /1-i /� ..._ # S�'l
NATURE of w• / -e
NEW RELAY REPAIR INTERIOR
SAN SEW
W
ATER J 1 #
JATE
I SEW Bathtub Sump Pump
( Lavato. ► jillb Ejector
r Toilet C 7 Water Softener
InammoN DATE INSPECTION DATE Kit. Sink Drinking Fountain
Sink(other) Urinal
1 ' , Wgterheater 1 Slop Sink
1 Shower A Grease Trap _
Floor Drain Local Waste
Laundry Tub Site Drain
J am- Disposal Laundry Standpipe
/i 7/, S Dishwasher Catch Basin
l
** Violation notes on the reverse side