HomeMy WebLinkAbout1990-Electric (service change) CITY OF OSHKOSH N° 19002
� PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC�PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � �- 0�`'�f'"'«" � PLAN NO.
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OWNER . -`�- � �•
DESIGNER i
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USE/NATURE OF WORK �,/�`�^��� ��-iz�""�Za � � � � � � "�'
5� - l�o
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' ('ONTRAC'TOR {; - ��� �
Electric Serv. New ❑ Change Temp ❑ Typ��n� Volts �f `� Amps �d �
7
Fixtures Switches Receptacles Circuits s
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
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FEES: Valuation $ �_ Permit Fee Paid $ //� Park Dedication $ ?
ISSUED BY `l Date�r7 "�.G �lLJ Final/O.P. f� � ',l� /�`
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE / v����� �� ��y " ' �� �y��� ` v
A,G/ENT'OWNER DATE
ADDRESS � �� y L �'�^-� S / � �I �( �,35 -�/S Z
TELEPHONE#
AFFIDAVIT F3ELATING TO SECTION 13•12 (c ) OF A GENEAAL OHDINANCE
, OF THE CITY OF OSHKOSH 13ELATING TO TF� LZCENSING OF ELECTAICIANS
� AND PAOVIDING PENALTIES
� 3TATE OF WISCONSIN)
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WINNEBAGO COtJNTY )
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eY�, � �l� , j ? � �r L �i�,� � �, —
Na� Address
first being duly sworn on oath, deposes and says that he is not
a 2laensed e].ectrician in the City of Oshkosh and that he has
applied Por an electrical permit to do electrical work in a
residenae and/or auziliary buildings (intended solely for pur-
poses associated xith a resldence) which is owned and occnpied
bq him, or is being constrvcted in his name, as his personal
home and that said residence or auxiliary bu11d1ngs being so
wired are not to be used ar erected for rental purposes or for
resale to present or proapective purchasers.
Affiant understands that the electrical work authorized by
the permit applied for in coanection 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
faaily.
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Dated this � U day of � ,�r�--�.� , 19,�,��
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Subscribed and swoxzi to before
this � day of . 19`L•
" Notary :,ubllc, Winnebago County, Wisconsin
� My Cummission Expires: 1
�ERMIT NO. ���� • � L. DATE -Z O ��
c^,LEC. CONTR.
OWNER .,�
� !/� �G�`G'"/�C
ADDRESS /'Z � r� ��"��� �
NATURE OF WORK
C. SERV. NEW CHANGE TEMp•
D C TYPE" ' �v- � tc� ck-VOLTS l2�3 �L' P+P'IPS%O
FIX' S SW' S RECEPT`5 CIRC S
APPLIANCES Y
•4c l<
SIGNS SERVICEdK ��° t FINAL � %G
INSP ROUGHIN � ���- DATE PD/ o2a-3'O
EST COST s2 �� PERMIT FEE /)
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