HomeMy WebLinkAbout2001-Electric (new service) Division of Inspection Services
215 Church Avenue
P.O. Box 1130
' Oshkosh, WI 54130
Fax (920) 2903 -1
36 -5084
ON THE WATER
Phone (920) 236 -5046
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
DATE 4/22/0
JOB ADDRESS �, (1 , ,Zaatr) Avg
OWNER 0 . V\ . S9F-C ipt I ,Z1-'3
CONTRACTOR i 6 — i - 6 t - L, , ` ,
CIRCLE ALL APPLICABLE
USE CATEGORY SINGLE FAMILY DUPLEX MULTI- FAMILY RENTAL .0 MERC INDUSTRIAL
SERVICE NEW HANG TEMPORARY NOT APPLICABLE
TYPE OVERHEAD DEI --------1 - - MRW NOT APPLICABLE
NO. OF FIXTURES SWITCHES RECEPTACLES CIRCUITS
AMPS 2) VOLTS //,'S / 2(5r PHASE T rii
CHECK ALL APPLICABLE
RANGE WATER HEATER GARBAGE DISPOSAL DRYER
DISHWASHER FAN OR BLOWER FURNACE A/C
ELECTRIC SIGN MOTORS GAS PUMPS OTHER
DESCRIPTION OF ALL WORK BEING DON it 3 -k1 L Aq?Oc:rJW - '2R i )
• 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 labQbr =nd all mater' = • ncluding light fixtures) $ '70OO
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MASTER ELECTRICIAN I', 4 (j&