HomeMy WebLinkAbout0028183-Plumbing (abandon 2nd floor bath) � CITY OF OSHKOSH N° 28183
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG [� SIGN :
❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS �5 �''� � T r �
PLAN NO.
OWNER �-�—��-�--�' � .
DESIGNER
C) /J
USE/NATURE OF WORK � N '"� 6�
� P� � ��. " _
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATIN� 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 �
1 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 $ �s � •� � Permit Fee Paid $ � v ' � � Park Dedication $
ISSUED BY w �� Date � �� `� �-- Final/O.P. 5 -/ - � =�
Y
In the performance of this work I agree to perform all work pursuant to rules governing the described constiuction.
SIGNATURE t�L�!"�f��� �\1��`-��"'---- �-ZZ- -� Z
AGENT/OWNER DATE
ADDRESS_ 7� �l�,j , ���^ �Cl_►�. �������>� �,�/- O�77jL� :
TELEPHONE#
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�Name • Address
being first duly sworn on oath deposea and says that he is not
a licensed plumber, and that he has applied for a plumbing
permit to the Plumbing Iaspector of the City of Oshkosh, to do
plumbing w�ork in a home owned and occupied by him, or a home
that is being conatructed that is owned by him, and which will
be occupied by him as his home when completed. That he is not
building said hocne. for the purpoae 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 plucaber except that the plumbing wor!c `
may be done by one who awna and occupiea his own home providing
the inatallation complies with the plumbing code� of the City of
Oshkoah and the State of Wisconain.
� Thia affiant uaderstands that the Plumbing wo rk authorized
by the pezmj.t applied for, must be done only by this affiant and
t that he cannot employ others who are not licensed plumbers to
assist with the work. '
Dated this ��� day of �ti-'���� . 19 �-���,_. ,
��ti�n,2sL ��-��" '
Subacribed and swcrn to before me .
this �� day of , 19 ��.
L ; �
tz- �
Notary ublic, Winnebago County, Wisconain
My Cocacnts s icn Expi res:
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