HomeMy WebLinkAbout0003603-Plumbing (1/2 bath on 2nd floor & wc in basement) � _ CITY OF OSH KOSH No _ 03603
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PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG �SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � PLAN NO.
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OWNER
DESIGNER
USE/NATURE OF WORK ` � �
,
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
PWMBING CONTRACTOR � �L��'ti__
—BT —WH Disp —WSoft _CBasin
�Lav _Sh _DW —DF —San. Sewer
�WC —FDr —SP —Ur _Storm Sewer
—Sink _LTub —Eject —SS —Water
Other
�y� G�
FEES: Valuation $�� P it Fee Paid /,�� Park Dedication $
ISSUED BY �.i� �> Date J,G,�/� Final/O.P. /1"'�-��
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE � –
GENT/OWNER DATE
ADDRESS
TELEPHONE#
PLIJMBING PERMIT APPLICATION
PLUMBER ��*yt-��.-- DATE � / �3���
NAME OF OWNER G ADDRESS 7
l � � aU� d- C.v�. �� !o
NEW SAN. WATER STORM RELAY SAN. WATER STORM
Main to Curb Main to Curb �
Curb to Bld . Curb to Bld .
Elect. Pum s Re air
Se tic Tanks
NEW REP. NEW REP. NEW REP.
Bath Tub Gar. Dis osal Catch Basin
Wash Basin Dishwasher Conductors
Water Closet Laundramats Grease C.B.
Sink Water Softener Sum Pum
Water Heater San. Bu�blers Bar Wastes
Shower Bath Urinals Ran e Boiler
Floor Drain Dental Cus idors Future Outlets
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STATE OF WISCONSIN )
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WINNEHAGO COUNTY )
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acn • � Addre s
being girst 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 Plumbinq 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 af�idavit is cnade for the purpose of complying with
the prcvisions of the plumbing code of the City of Oahkosh and
the State of Wiscoasin, which provides that all plumbing work
must be done by a licenaed plumber except that the pinmbing wor!:
caay be done by one who owns and occupies his own home providing
the installation complieg with the plumbing code of the City of
Oshkoah and the State of Wisconain.
This affiant understands that the Plumbing work authorized
by the permit applied for, muat be done only by this affiant and
that he cannot employ cthera who are nct licensed plvmbers to
assiat w3th the work.
Dated this ,� day of . 19 .
'���.
Subscribed and sworn to before me
this � day of �� , 19�.
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Nota ry Public, Winnebago County, Wisconsin
My Commisaion Expirea: ��� ,�fR9C !