HomeMy WebLinkAbout0038425-Plumbing ��� 4
� CITY OF OSHKOSH N° 38425
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG �J SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS �l� � 1�� PLAN NO.
. OWNER �-� /���y(,-c�z�t'
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
,
�
Fi�ures 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 $ �°� �� � � � Permit Fee Paid $ �"� "d� Park Dedication $
ISSUED BY Date FinaUO.P. �'�C/ 7
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE__ ���.���I�'✓ / r l`��1� ✓ ` �l — �/C�
AGENT/OWNER DATE
ADDRESS �! Z � /��C�ll �-��/�/� �3�5'����
TELEPHONE#
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�%G��� , ,3/y �' e�J � �
Name • Addresa
being first duly sw�orn on oath deposes and says that he is not
a Iicensed plumber, and that he has applied for a plumbing
permit to the Plumbing 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 wi1.l
be occupisd by him as his home when completed. That he is not
building said home_ for the purpose of sa1.e.
This affidavit is cnade for the purpose of complying with
the provision� 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 licenaed plumber except that the plumbing wor!c
may be done by one who awns and occupies his own home providing
the inatallat3on complies with the plumbing code� of the City of
Oshkosh and the State of Wisconain.
This affiant understands that the Plumbing wo rk authorized
by the pesmit applied for, must be cione onZy by this affiant and
that he cannot emplay othera who are not licensed plumbers to r
! assist with the work.
Dated this // day of �l��2-�� . 19 � . t
� � �
�,/��i /'6 l'�.Cc� '
s
Subacribed and swnrn to befose me
this �� da y of �A Q c_� , 19�.
Nota ry public, Winnebago County, Wisconsin
My Co�xmission Expires: �
INC PERMI? APPLZCaZZON
ADDRESS .�/1 � �'-2.��: �'"Z��� DATE � /� �' PERI�?� -3��1_s"
OiWNEB ``�-� ` , PLII�EB Gl-uy-�
x�TUaE oF Woctx �1 � ` --
NETJ RE7.AY REPAIR INTERIOS
SAN SEW � #
�JATEA Bathtub Sum Pu
Lanato Ej ector
Toilet Water Softener
NSPECTZON DATE INSPECTZOH DATE ( Rit. Sink Drinkin Fountain
S iak(o ttser •
� � �1� � W te heater Slo Sink
G ease Tra
� � Floor Drain Local Waste
1 J y� Laundry Tu Site Drain
/ � Dis osal Laundr Stand i e
Dishwasher � Catch Basin
� '
,�+ . — �� �
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** Violation notes on the reverse eide