HomeMy WebLinkAbout0036652-Plumbing (water heater) ���
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CITY OF OSHKOSH N°- 36652
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG� SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS_ ���''� /l✓� �'T/j� /�(C
PLAN NO.
OWNER S6-�ctiti S �
DESIGNER
USE/NATURE OF WORK
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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
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ELECTRIC CONTRACTOR
y
� Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits �
PLUMBING CONTRACTOR G_
—BT _WH _Disp —WSoft _CBasin �-
—Lav � _Sh _DW _DF —San. Sewer
—WC _FDr —SP —Ur —Storm Sewer
—Sink _LTub _Eject —SS _Water
Other
FEES: Valuation $ �Sd• �'� Permit Fee Paid $ ��• � a Park Dedication $
ISSUED BY � Date � � 93
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction
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SIGNATURE `� C�. � � ��1 � �.i C��i�(_/� � I
' , AGENT/OWNER DATE
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being first duly sworn on oath deposes and says that he is not
a Iicensed plumber, and that he has applied far a plumbing
permit to the Plumbing Inspector of the City of Oshkosh, to do
plumbir�g w�ork in a home owned and occupied by him, or a home
that is being conatructed that ia owned by him, and which wil.l ;
be occvpied 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 purpoae of cocaplying with
the provisions of the plumbing code of the City of Oshkosh and
the State of Wisconsin, which provides that all plumbing work
muat be done by a licensed plumber except that the plumbing wor!c
may be done by one who owns and occupiea his own home providing
the inatallation complies with the plumbing ccde� of the City of
Oshkosh and the State of Wisconain.
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This affiant understands that the Plumbing wo rk authorized
j by the permit applied for, must be done only by this affiant and
that he cannot ecaploy others who are not licensed plumbers to '
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assist with the work.
Dated this �„_ day of /l,�V ` . 19 ,.
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Subacribed and sworn to before me
this L�, day of � , 19 �_� .
Notary P lic, Winnebago County, Wisconain
My Cocnmisaion F�cpires: � (