HomeMy WebLinkAbout0017471-Plumbing � � _ CITY OF OSHKOSH N°_ 17471
PERMIT APPLICATION AND RECORD
►
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG��SIGN ❑ ZONING FLOOD PLAIN HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -� - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ADDRESS G ' PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK_���� ��'7Z" ������,c� �(L��(� /<.'��.,�
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 CONTRACTOR� .l_�ll eic._
—BT WH Disp —WSoft CBasin
�Lav �Sh DW DF San. Sewer
� WC FDr SP Ur Storm Sewer
—Sink LTub Eject —SS Water
Other
. /�7 rv �.�
FEES: Valuation $(?�C) Permit Fee Paid $�� Park Dedication $
7
ISSUED BY���� Date 5�-Z"�� Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE -v ��'' "`��� � �a ��
�
AGEN /OWNER DATE �
ADDRESS
TELEPHONE# �
i
" �
' i
�
�
STATE OF WISCONSIN )
) SS
WINNEBAGO COUNTY )
,,.�� � Sa� , Z � �� � I�
Name • Address
being first duly sworn 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 cecupied by him, or a home �
that is being constructed that is owned by him, and which will F
be occvpied by him aa his home when completed. That he is not F
building said home. for the purpose of sale.
S
This affidavit is caade for the purpose of complying with �
f
the provisions of the plumbing code of the City of Oshkosh and
the State of Wisconain, which provides that all plumbing wcrk �
must be done by a licensed plumber except that the plumbing wor� �
may be done by one who owna and occupies his own home providing �
the installation complies with the plumbing code� of the City of
Oshkosh and the State of Wiscona in.
This affiaat vaderstands that the Plumbing wo rk authorized
by the permit applied for, must be done only by this affiant and
that he cannot employ others who are not licensed plumbers to
assist with the w�ork.
Dated this /2- day cf /1i1 �'�'c ti . 19�.
Subacribed and sworn to before me
this � da of , 19 9d .
�����
Nota blic, Winnebago County, Wisconsin
.
My Cocamission Expires: ,e 9
.
�UMBI G PERMIT APPLICATION
ADDRESS_ <�LI C�Zr G� DATE_� /'..���� PERMIT�� ��%, �I
OWNER � � . �� ' PLUI�B�R T���'C�ti., .�3/ ����-5--
NATURE OF WORK _ �` .i-� i}�'L-, /,�v���. , /� �:>_. .�
NEW RELAY REPAIR INTERIOR
, SAN SEW �� ��
WATER Bathtub eatch Basin
TORM SEW Lavator Grease Trap
' � Toilet Sum Pum
INSPECTION DATE INSPECTION DATE Kit. Sink Local Waste
j _ � Sink(other) � Site Drain
��s / �j��4,c� i f� ��G/;' ' Shower Laundry Stand Pipe
� Floor Drain Laundr Tra
�� � Q ���'� Dis osal Wat. Softner
� °°`''-r-�s - `'iti ��,`i �� ,�.fFr'� � �/'���'� Dishwasher D. Fountain
�'� Water Heater Ejector
0� /�/y�/f-r'Q rinals Future outlets
** Violation notes on the reverse side