HomeMy WebLinkAbout0010005-Plumbing (remodel 2 bathrooms) t
n CITY OF OSHKOSH No 10005
`' PERMIT - APPLICATION AND RECORD
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TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG`'�SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS PLAN NO.
OWNER � ` / C-E' `
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
PLUMBING CONTRACTC�R � �'
%2 BT �WH —Disp —WSoft —CBasin
�2 Lav —Sh �DW —DF —San. Sewer
�WC —FDr —SP —Ur —Storm Sewer
�Sink —LT b —Ej t —SS —Water
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Other �
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FEES: Valuation $� Permit Fee Paid Park Dedication $
ISSUED BY – Date Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE y���e'�
, AGENT/OWNER DATE '
ADDRESS
TELEPHONE#
Y
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STATE OF WISCONSIN )
) SS
WINNEBAGO COLJNI'Y )
a-�r�c_�C O� I�e�1l , 033 w ? '� c,e
Name • Add res s
being first duly sworn on oath deposes and says that he is not
a Iicenaed plumber, and that he has applied for a plucnbing
permit to the Plumbing Inspector vf the City of Oshk,osh, to do
plvmbing work in a home owned and occupied by him, or a home
that ia being conatructed that is owned by him, and which will
be occvpied by him ae his home when completed. That he is not
building said home gor the puzpose of sale.
This affidavit ia made for the purpoae of complying with
the provisions of the plumbing code of the City of Oahkosh and
the State of Wisconain, which pr�vides that all plumbing work ;
must be done by a licensed plumber except that the plumbing work
may be done by one who awna and occvpies h1s own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the State of Wisconsin.
This afgiant understands that the Plumbing wo rk authorized
by the permit applied �or, must be done only by this affiant and
that he cannot employ others who are not licensed plumbers to
assiat with the work.
Dated this Z3 day of Auqur� , . 19 ��
�i'� �J G� '
Subacxibed and sw+orn to before me
this ,%� day of �, 19,�,�.
�
Notary lic, Winnebago County, Wisconsin
My Commisaion Expirea: ( 7 Q �
P UMBING PERMIT APPLICATI
ADDRESS � DATE PERMIT�k �(,��
OWNER �r PLU1��R �'�(LYf,�.� _
NATURE OF WORK
NEW RELAY REPAIR INTERIOR -
SAN SEW �� ��
WATER Bathtub Catch Basin
RM SEW � Lavator Grease Trap
Toilet Sum Pum
INSPECTION DATE INSPECTION DATE Kit. Sink Local Waste
I� y/ Sink(other) Site Drain
�� / � Shower Laundry Stand Pipe
Floor Drain Laundr Tra
� � Dis osal Wat. Softner
�r/�� � �����- �� � w,�- fia �:� �;Sr :
Dishwasher D. Fountain
3'�" � ���� Water Heater Ejector
��,p �y .2J 1�,��D(;y�� d S� �� inals Future outlets
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** Violation notes on the reverse side