HomeMy WebLinkAbout0029947- Electric (Add new) ® I 4 CITY OF OSHKOSH N° 29947
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG C ELEC' PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 7 /A1' �`4" PLAN NO.
OWNER 0 06D4
,0
DESIGNER
USE/NATURE OF WORK K,
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
t Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
t
ELECTRIC CONTRACTOR ea,„-a4
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches 6 Receptacles /S Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation $ ( ' 0 Permit Fee Paid $ r O' 0 O761.0O Park Dedication $
ISSUED BY Date 7/3//9 2 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE (i7jcu t �'U— '7 -37-10.2
AG /OWNER DATE
ADDRESS
TELEPHONE#
AFFIDAVIT RELATING TO SECTION 13.12 (c ) CP A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
,Nr( I YLn 13 -
(Name
Address
first being duly sworn on oath, deposes and says that he is not
a licensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or auxiliary buildings (intended solely for pur—
poses associated with a residence ) which is owned and occupied
by him, or is being constructed in his name , as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
the permit applied for in connection with this affidavit , must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this 1 day of 19(;--/ •
d
Subscribed and sworn to before
this 1 day of # ' ' , 19,..
j57- /
Notary / ublic, Winnebago County, Wisconsin
My Cclt;mission Expires: .2
PERMIT NO. '1 APPL. D � 7- Y
ELEC. CONTR.
OWNER G�—
ADDRESS 4/7 - // tee-1.41
NATURE OF WORK
LeZ(
ELEC. SERV. NEW CH TEMP•
/ DESC. TYPE VOLTS AMPS
FIX' S SW' S RECEPT' S /s CIRC' S
APPLIANCES
SIGNS
INSP. ROUGHIN Ck'4--0"61 P' SERVICE F INALtJOI4
EST. COST oc' - PERMIT FEE /O DATE PD.7-3/
REMARKS