HomeMy WebLinkAbout0020719- Electric (Repair Riser) CITY OF OSHKOSH N° 20719
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ( ?`/ tidal-A' PLAN NO.
OWNER %7//14- ,-1J.
DESIGNER
USE/NATURE OF WORK Xi .:t /-d1 c
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 /e"--
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
lig
Fixtures Switches /. Receptacles Circuits 7 -
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
p G a c
FEES: Valuatio $ `' v ` Permit Fee Paid $ /�'�q--/� Park Dedication $ -7J
ISSUED BY `/ 1� �� Date /d— / —fes Final/O.P. 7" /^ 5 '`
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNAT 'E i - !v --7--�Q
AGENT/OWNER DATE
ADDRESS
TELEPHONE#
PERMIT NO. -4ZO 7// • APDL. DATE 9 - ;?-1( -527
ELEC. CONTR. fifff•-e/41-€ ‘11/4----
OWNER "M.A'! L "o T_.c-Z—
ADDRESS 9-47i( - / "/%2-7X
NATURE OF WORK .I
ELEC. SERV. NEW / CHANGE TEMP .
DESC. TYPE -3 - U.- - L VOLTS /��y O AMPS
FIX' S SW' S RECEPT' S CIRC' S
APPLIANCES
SIGNS C G.cG
INSP. ROUGHIN SERVIC 7.Z>_9!i FINAL ?-..454
EST. COST .5 C PERMIT FEE /C5-1 DATE PD./D--tr'"z
REMARKS