HomeMy WebLinkAbout0115805-Electric (repair service)
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OSHKOSH
ON THE WATER
Job Address 1024CEAPEAVE
CITY OF OSHKOSH
No
115805
ELECTRIC PERMIT. APPLICATION AND RECORD
Owner
LYNN E/SANDRA L MATUSZCZAK
Create Date 08/16/2005
Contractor
HOMEOWNER
Category 634 - Residential-Service Change
Plan
Service 0 New
Volts 1201240
Amps 100
. Change
0 Temp
0 N/A Type . Overhead
Circuits ~
Switches 0
0 Underground
Fixtures
~
Receptacles ~
Appliances
Use/Nature of FR I Replace the service entrance damaged from tree debris (Emergency repair)
Work
Fees: valua~ $400.00 Plan Approval
Issued By: l!> ~-'-"-
n Penmit Voided I
$0.00
Penmit Fee Paid
$20.00
Date 8/17/05
Parcelld # 0802710100
The undersigned, in applying for an Electric Penmit to peñonm 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 perfonm all work pursuant to nules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the penmit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature ffi~ I. /)¡ ,¡z~
AgenVOwner
Address /Od-</ &a(~ ~ OSHKOSH WI 5490 - 5420
Date tf'/17Ios-
Telephone Number ;1.3'3 - 37 J7 /
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
~
CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: \o'd--I{ t~~<..>
CONTRACTOR: ~<- ~ .::;~
PROJECT TO BE INSPECTED: ~~~
TYPE OF INSPECTION: 5G('""~ ~<..-e->
~
rityOfOshkosh
)pection SoMces Division
_is Church Avenue, PO Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax (920) 236-5084
Violations must be corrected and approved within 30 days unless otherwise noted. Call for re-inspections prior to concealment
and/or occupancy. Upon completing the corrections, the owner/contractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of
INSPECTION RESULTS
¿
f~C1'm~Ä
0 Not Approved! Insp. Report left on site -KNot Approved! Insp. Report given to 6'-"J ""A!../"
Signed ~~Þ- <6f1:(; of"
Inspection Services Division D ofInspection
0 Mailed/Faxed
Print Name
Company
Signatirre:
Date