HomeMy WebLinkAbout0099110-Electric (remodel)OSHKOSH
ON THE WATER
Job Address
Contractor
Service
Volts
2655 N MAIN ST
CITY OF OSHKOSH
ELECTRIC PERMIT -APPLICATION AND RECORD
VAN ERT ELECTRIC
~) New (~ Change (~ memp
Amps 0
Owner
Category
CI¥1ZENS FIRST CREDIT UNION
643 - Commercial-Addition/Remodels
Type O Overhead
Circuits 0
Switches 0
No 99110
Create Date 12/17/2002
Plan
(~) Underground
Fixtures
Receptacles
0
0
Appliances
Use/Nature of 30MM/Remodel lighting & power. *Job #F1288BK.
Work
Fees: Valuation
Issued By:
$3,000.00 Plan Approval
$0.00 Permit Fee Paid $75.00
[] Permit Voided
Date 12/17/2002
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 2000 PROGRESS WAY KAUKUANA WI 54130 ~ 0 Telephone Number
920-766-3888
12/~6/0£ 10:06 FAA 920 766 0883
City of Oshkosh
Division of Inspection Services
P,O. Box 1130
Oshkosh, WI 54903-1
Phone (920) 236-$050
Fax (920) 236-5084
VAN ERT ELECTRIC
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete app[icntio,,~ will uot be proc~sed.
~00~
OI'HKO_/H
ON THE WATER
Application(s) and fee(s) can be brought to City HaH, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1 !28. Commencing work without permit(s) will result in fees being doubled or $100.00 plus
normal permit fee., which ever is greater.
OR
Fo, u are a contractor participating in the Permit Fee Account System and. have..ad.e~_a_t_e fundz, check h
if you want this proeeis.e,d~hrou~,h your account ~
cOrm~CTOa k//~ ~ C
CHICK IPi ALL APPLICABLE
USE CATEGORY
?9Single Family l-]Duplcx
E3Multi-Family
SERVICE [3~Tew
KIChange
]~blot Applicable
12RcntaI ~Commercial Dlndustrial
TYPE DOvcrhcad ~qot Applicable
IZUnd~rground
I~LI, IN ~ APPROPRIATE BLANK WITH THE NUMBER
Volts , / Receptacles #
Phase
Amps Switches !
Circuits #
Fixtures #
CITI~CK E] ALL APPLICARLE
~Rangc ['lDishwashcr
ClFan OR Blower E]Fumace
IqMotors []Oas Pumps
EIGarbage Disposal ElDrycr
I'3A/C DElcctric Sign
DO~cr
DWatcr Hcat~
DESCRIPTIODLOF ALL WORK Bli [NG DONE
VALUE (Including labor and all materials including light fixtures) $ ~.. ~ 0 ~
MASTER EleCTRICIAN /I"~ _~ U~ ~.~ .-