HomeMy WebLinkAbout0099139-ElectricOSHKOSH
ON THE WATER
CITY OF OSHKOSH
ELECTRIC PERMIT - APPLICATION AND RECORD
JobAddress 855 N WESTHAVEN DR Owner
Contractor WITZKE ELECTRIC Category
Service ~) New O Change
Volts Circuits
Amps 0 Switches
AURORA MEDICAL GROUP INC
643 - Commercial-Addition/Remodels
Type (~)Overhead
0
0
No 99139
Create Date 12/19/2002
Plan
(~ Underground
Fixtures
Receptacles
Appliances
Use/Nature of 2OMM/Provide & install 110 volt rec extended from existing rec.
Work
Fees: Valuation $125.00 Plan Approval $0.00 Permit Fee Paid $20.00
Issued By:
Date 12/19/2002
[] Permit Voided
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address PO BOX 102 155 E PACKER AVE OSHKOSH WI 54903 - 102 Telephone Number
920-235-6572
WITZKE ELECTRIC
ELECTRICAL PERMIT APPLICATION
All mform~tion afe:r bold categories must be provided,
Incon~plete applications will not be processed.
HO.114 P.4/4
Application(s) and fcc(s) can be brought to City Hall, Room 205 or mail¢cl to Inspection Services, PO Box 1128,
Os~sh WI '54903-1128. Co--toeing work withoul p~it(s) will result ~ tees ~g doubled or $100,00 plus the
no~al pe~t fe~, which ever is ~eater.
OR
are a contr~c.t.~_~arrtctpatine t~ the Permit ~e~ ~caOunt Sy~am a~d ha~e adequ~t~.~d~, che~ her~
want this ~rocexxed throu~b vour account ~
,lOB ADDRESS ,.~ -
CHECK ~ ALL APPLICABLE
USE CATEGORY
I~ Sin~e Family [3Duplex
~Multi-Family
SERVICE [DNew
UChang¢
plicable
E3R. ental
TYPE
ElOwrhea~i [iil'~ ot~ot Applicable
DUndcrsround
FILL IN THE APPROPRIATE BLANK WITH TI~- NUMBER
Volts _ / Receptacles ~ {'
Phase
Amps Switches #.
Circuits #,
Fixtures #
CHECK ~ ALL APPLICABLE
all n~tt, rio il~ell d ag li['l~ fixtures) $ /&...e~ __...
VAL[.~ (Includin8 labor and all Lt~ rial
MA~I'ER ELECTRICIAN
&O