HomeMy WebLinkAbout0099577-Electric (receptacle)OSHKOSH
ON THE WATER
Job Address
Contractor
Service
Volts 120
1707 PUNHOQUA ST
LARK ELECTRIC
[~ New (~ Change (~ Temp
Amps 20
CITY OF OSHKOSH
ELECTRIC PERMIT - APPLICATION AND RECORD
Owner SHIRLEY R HOREJS
Category 612 - Residential-Single Family Addition/Ret
Type I~ Overhead
Circuits 0
Switches 0
No 99577
Create Date 01/24/2003
Plan
~ Underground
Fixtures
Receptacles
Appliances
Use/Nature of SFR/Install receptacle
Work
Fees: Valuation
Issued By:
$500.00
Plan Approval
$0.00 Permit Fee Paid
$20.00
Date 01/24/2003
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 927 N LARK ST PO BOX 3206 OSHKOSH WI 54903 - 3206 Telephone Number
920-231-8625
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
O/HKO/H
ON TH~ WATER
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if you want this processed through your account []
DATE 2 I -.-Tt¢,~z C>~
JOB ADDRESS
OWNER 5-/-//
CONTRACTOR
CHECK [] ALL APPLICABLE
USE CATEGORY
IESingle Family I-3DuPlex l-lMulti-Family
SERVICE EINew FITemporary
[3Change F1Not Applicable
F1Rental
TYPE
ElCommercial [Dlndustrial
I-1Overhead [3Not Applicable
ElUnderground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts t ~. o / Receptacles # ~
Phase /
Amps - ,20 Switches #
Circuits #
Fixtures #
CHECK [] ALL APPLICABLE '
[3Range F1Di'shwasher F1Garbage Disposal
F1Fan OR Blower F1Fumace [3A/C
[]Motors []Gas Pumps [2 Other
DESCRIPTION OF ALL WORK BEING DONE
[3Dryer
[3Electric Sign
ElWater Heater
VALUE (Including labor and all materials includi~tures) $
MASTER ELECTRICIAN F_~"~ i
3/02