HomeMy WebLinkAbout0099642-ElectricOSHKOSH
ON THE WATER
CITY Old'OSHKOSH
ELECTRIC PERMIT - APPLICATION AND RECORD
JobAddress 1324 BISMARCK AVE
Contractor ZIMMER ELECTRIC LLC
Service ~) New C) Change C) Temp
Volts
Owner
Category
Circuits
JAMES R SUMRALL
612 - Residential-Single Family Addition/R
Type (~) Overhead
0
Amps 0 SWitches 0
No 99642
Create Date 01/31/2003
Plan
(~ Underground
Fixtures
Receptacles
Appliances FAN
Use/Nature of SFR/Remodel bathroom, lighting and fan replacement* LATE PERMIT
Work
Fees: Valuation ~. _~3~j Plan Approval /$0.00
Permit Fee Paid $120.00
Date 01/31/2003
In the performance of this work I agree to perform alt work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
OMRO WI 54963 - 0
Address 400 E SCOTT ST Telephone Number 920-685-2387
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
O/HKO/H
ON T~F \-VATER
· 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 /,/~ .~/L'~_..~
CltECK [] ALL APPLICABLE
USE CATEGORY
J~l'Single Family F1Duplex FIMulti-Family
SERVICE FINew [3Temporary
[3Change /~Nlot Applicable
F1Rental
TYPE
[] Commercial []Industrial
[3Overhead [~ot Applicable
[3Underground
FILL IN THY APPROPRIATE BLANK WITH TIlE NUMBER
Volts / Receptacles #
Phase
Amps Switches #
Circuits #
Fixtures #
CHECK [] ALL APPLICABLE
F1Range r-IDishwasher [3Garbage Disposal
[3Fan OR Blower [3Furnace [3A/C
r-lMotors []Gas Pumps []Other
DESCRIPTION OF ALL WORK BEING DONE /~ '~- 7'/,~,
F1Dryer [3Water Heater
F1Electric Sign
VALUE (Including labor and all ma~j~Is including~g)ht fixtures) $ Y C> (~
MASTER ELECTRICIAN //~-"Z /e~
3/02