HomeMy WebLinkAbout0099030-Electric (3-seasons room) � � ' • � CITY OF OSHKOSH No99030 scqtie, _
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. OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD o '�'� ° `
ON THE WATER 9TF
Job Address 2390 GOLDEN AVE Owner DAVID/BARBARA KERSZTYN Create Date 12/06/2002
Contractor A&S ELECTRIC LLC Category 612-Residential-Singie Family Addition/R Plan
Service New � Change � Temp Type � Overhead � Underground �
Volts Circuits 0 Fixtures 0
Amps 0 Switches 0 Receptacles 0
Appliances
Use/Nature of FR/LATE PERMIT/Wiring for new 12x 16 three seasons r000m.
Work
Fees: Valuation $850.00 Plan Approval $0.00 Permit Fee Paid $40.00
Issued By: Date 12/11/2002
� Permit Voided I
In the performance of this work I agree to perform all work pursuant to rules goveming the described construction.
Signature Date
AgenUOwner
Address 1008 W NORTH AVE LITTLE CHUTE WI 54140 -0 Telephone Number (920)78&6650
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� Division of Inspection Services � `� `1�
� 215 Church Avenue ��� . �
P.O. Hox 1130 ��� • �
oNT„� Oshkosh, WI 54903-1130 ��
Fax (920) 236-5084
Phone (920) 236-5046 DEC 0 9 20�J[
DEPARTNiENT OF
ELECTRICAL PERMIT APPLICAT ONI�Y �EVELOPMENT
All information after bold categories must be provided.
Incomplete applications will not be processed.
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JOB ADDR$S S ,�_�S� �6� �
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CONTR.ACTOR �•,�S" �l�G�t'��� L1(°
CIRCL$ ALL APPLICABL}3
USB CAT$GORY SINGLE FAMILY DUPLEX MULTI-FAMILY RENTAL COMMERCIAL INDUSTRIAL
SBRVICE NEW CHANGE TEMPORARY NOT APPLICABL
TXP$ OVERHEAD UNDERGROUND NOT APPLICABLE
NO. OF FIXTURES SWITCHES RECEPTACLES CIRCUITS
AMPS VOLTS / PHAS$
CHECK ALL APPLICABLS
RANGE WATER HEATER GARBAGE DISPOSAL DRYER
DISHWASHER FAN OR BLOWER FURNACE A/C
ELECTRIC SIGN MOTORS GAS PUMPS OTHER
D$SCRIPTION OF ALL WORK BBING DONE__ j„��,�� �l� ���� y�
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• Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100 .00 plus the normal permit fee, which ever is
greater.
VALUE (Including labor and all materials including light fixturas) $ ���, �/y�
MASTBR SLBCTRICIAN ,rq��,y �� L '� �
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