HomeMy WebLinkAbout0006623- Electric (bathroom) CITY OF OSHKOSH N2 06623
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC K PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 9 y/` /z...,/_!l .
PLAN NO.
OWNER ' GZ-Zl1 ` 2e-L-1/17 r
DESIGNER ( ,
USE/NATURE OF WORK ✓� 1-i fA ' >- -- !
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat 111A/C ❑ Vent [I] Fuel/System Heat Loss BTU'S
14
//
ELECTRIC CONTRACTOR
/
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts A s
Fixtures Switches Receptacles1�Circuits— _0 /
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 $ / ..5-"D ermit Fee Paid $ / 2 G'` Park Dedication $ .r
ISSUED BY��� Date/-2--- Final/O.P. 3' /7 '8
i
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE akC- L-AM \a-a.a'8--/
AGENT/OW DATE
ADDRESS 1 q \ \—iNg--V--- --1-7 3-(oP)S(0
TELEPHONE#
AFFIDAVIT RELATING TO SECTION 13 .12 (c ) CF A GENERAL ORDINANCE
OF THE CITY OF OSEEOSH RELATING TO TEE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
4
(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 otoe day of \,neo , 19_x .
Subscribed and sworn to before '
r,rz
this , c)(1 , day of ,
�C9kQ0, . McdvaL
Notary Public, Winnebago County, Wisconsin
My Commission Expires: Skilggn
l —
GG
PERMIT NO. te() /� . APPL. DATE ! O7
ELEC. CONTR.
OWNER '-'927‘14.,C-- /
/
9
ADDRESS "/ /V
7 'f-�'0z
NATURE OF WORK d2. mix. C «2w—--w---/J---el
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX' S ,74�SW' S C '_ RECEPT' S .-0/� CIRC'S P .
APPLIANCES
( Jt �,
SIGNS
INSP. ROUGHIN 7�/`t'2" ' 21' SERVICE FINAL3 /7 $;
EST. COST ,T PERMIT FEE/- � DATE PD/.2--z-2-4
REMARKS