HomeMy WebLinkAbout0022423-Plumbing (water heater) /� CITY OF OSHKOSH N° 22423
` PERMIT - APPLICATION AND RECORD
TrPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG � SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS /� � � � � ��/��
, PLAN NO.
OWNER �` ����—�'—
DESIGNER
USE/NATURE OF WORK
BUILDING CONT'RACTOR
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 � �
Lav —Sh —DW _DF _San. Sewer �
—WC FDr SP —Ur —Storm Sewer
—Sink _LTub —Eject SS —Water
Other
FEES: Valuation $ 3 c o , D O Permit Fee Paid $ �� ' � � Park Dedication $
ISSUED BY � ` Date � °2 � Final/O.P. � aD � I
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ' �'�
` ENT/OWNER DATE
ADDRESS
TELEPHONE#
.
.
STATE OF WISCONSIN )
) SS
WINNEBAGO COUNTY )
5 5��� ��if/ , /� /� � �:
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 wcrk in a home owned and occupied by him, or a home
that ia being constructed that is owned by him, and which will
be occupted by him as his home whea completed. That he is nat
building said home for the purpoae of sale,
This affidavit is caade for the purpose of complying with
the provisions of the plumbing code of the City of Oshkosh and
the State of Wisconain, which prov3des that all plumbing work
must be done by a licenaed plumber except that the plumbing wor!c
may be done by one who owna and occvpiea his own home providing
the inatallation complies with the plumbing code� of the City of
Oshkosh and the State of Wisconsin.
This afgiant understands that the Plumbing wo rk authorized s
by the permit applied for, muat be done only by this affiant and
that he cannot employ others who are not licensed plumbers to
assist with the work.
Dat ed this � / da y of � . 19_G�.
Subacribed and sw�orn to befor me
this ,�l� day f � , I9�.
Notary Y;7.ic, Winnebago County, Wiscansin
My Coca�+ssion Expires: 7
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S
CITY OF' OSHKOSH, CODE ENFORCEMENT DIVISION, 215 CHURCH AVENUE, OSHKOSH, �IS':ONSLN 549U1 °
V/�DL.4 TIOIV/C ORR�E�TION /V O l'1�E
� ` DATF L11SP�CTED: ��,O g
OCCUFANCY INSPECTED S � _, �
ADDRESS � � �-�-
OWNERS NAME AND ADDRESS c�-n"'"
NOTICE DELIVER XPLAINE T0: ti •
ec: n
t
T� ORDER FINDINGS OF INSPECTION ;
. 1 . 20-8(A) Installation of plumbing without first obtaining a permit :
from the City Plumbing Inspector. ( i .e . replacement water I
heater , plumbing fixture or appliance ) �
**In buildings other than single family owner oc:upied dwellings :
a licenced plumber would be required for suc�� installation .
;,� ���� /�'i'� - ��-�- �'9 %�'l � / '� �'�
COMPLIe1NCE DATE: I(�`:i'ECTOR: Richard Wood •