HomeMy WebLinkAbout2001-Electric (dishwasher)
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OSHKOSH
ON THE WATER
Job Address 1419W3RDAVE
Contractor HOMEOWNER
Service 0 New 0 Change
Volts
Amps
Appliances I'-~
CITY OF OSHKOSH
NO 84696
ELECTRIC PERMIT. APPLICATION AND RECORD
Owner
EDWARD B/ JANET A WEISSE
Create Date 02116/2001
Cate90ry 612 - Residential-Single Family Addition/R
Plan
0 Temp
Type
0 Overhead
0 Underground
Circuits
Switches
Fixtures
Receptacles
Use/Nature of FR / wire dishwasher installation: Homeowner EIV form attached.
Work
$60.00
Plan Approval
$0.00
Permit Fee Paid
$0.00
Fees: Valuation
Issued By: v----
Date 03/15/2001
n Permit Voided I
The undersigned, in applying for an Electric Permit to perform electrical work within a single family home, owned and occupied
as the principle residence by the undersigned, hereby acknowledges per City Municipal Code Section 11-22, that other
individuals may not be employed to assist with the work described in this permit unless said individuals are licensed by the
City of Oshkosh to perform said work.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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Address EDWARJl JANET A WEISSE
Signature
Date
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Agent/Owner
OSHKOSH
WI 5490 - 5603
Telephone Number
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ChyofO,bko,h
Dimion on"",.,"on S"vi",
215ChUfOhAvenue
POBox 1130
O,bko,h WI 54903-1130
Offi" 920-236-5050
Fox 920-236-5084
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Electric Installation Verification
vie; -.';'J' ~
(print homeowner(s) name)
the homeowner(s) of J«/ c¡
hi ~.~-
(address where work is to be perfonned)
accept the responsibility for perfonning the electrical work as stated below for the property listed
above.
The nature of the work consists of: (Check One or Describe the Nature of Work)
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Reconnection or new circuit for replacement Heating Plant and/or AlC Condenser.
Reconnection or new circuit for replacement Electric Water Heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding I soffit installation. Note: New Service
Entrance Cables will require a separate pennit.
Reconnection or new circuit for other pennanently wired appliances I fixtures.
Other
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The value of this work is $ C::ð°':;::::
I hereby verify this work will be perfonned by me and further verify the reconnection I
installation will be done in compliance with manufacturer and Electric code requirements.
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0 Homeowner(s) Sigoature
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(Date)
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