HomeMy WebLinkAbout0012925-Electric
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
12925
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ADDRESS
OWNER
DESIGNER
~~
USE/NATURE OF WORK
~
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class ot Const.
HEATING CONTRACTOR
. Heat 0 AlC 0 Vent 0 Fuei/System Heat Loss BTU'S
ELECTRIC CONTRACTOR ~ '-
'",,", "",y'~ DOOM" D ,~, D-<T";;:~ 'o~- m~_-
Fixtures V '---. Switches {;¿{. - ~tacie~ Circuit'¿:::><;
6 <Vlþ' ~
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PLUMBING CONTRACTOR
_Lav
_WH
_Sh
_Disp
_OW
_WSoft
_OF
- CBasin
- San. Sewer
_BT
_WC
_FOr
_LTub
_SP
_Ur
_Storm Sewer
_Water
_Sink
Other
_Eject
_SS
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ISSUED BY
;;( {/ ~ (" Park Dedication $
Date lT~;l. ¿) - 157 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ffi~.ø::~
AGENT WNER
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9/2{)h¡
'DATE
ADDRESS
?-3:?-:::L..1õ.3
TELEPHONE #
.'
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) 5S
WINNEBAGO COUNTY )
Xo/7tr ~{~ g~u ~
Name
ff/rt ~/lh.eSSyST-
Address) (
first being duly sworn on oath, deposes and says that he is not
a licensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or aux1liary buildings (intended solely for pur-
poses associated with a residence) which is owned and oocup1ed
by him, or 1s being constructed in his name,. as his personal
home and that said residence or auxiliary bu1ldings be1ng so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
the perm1t applied for 1n connect10n w1th this aff1dav1t, must
be done only by th1s aff1ant and that he cannot emploY' others to
ass1st w1th the electr1cal work but members of h1s 1mmed1ate
fam1ly.
Dated this
20
day of -+N/
, 19l1
~~~
Sub;!Ç'.r1bed and sworn to before
-éß
this J(ó - day
, 19iî..
Notary ubllc, W1nnebago County, W1scons1n
My Commiss1on Exp1res: ~ 7 /??)--
f '
PERMIT NO.
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CHANGE
VOLTS
~ECEPT' S
TEMP.
AMPS
( Y-----... CIRC' S ~
~~-
ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVo NEW
DESC. TYPE
TIX' S C/--- SW ' S
APPLIANCES
SIGNS , .
INSP. ROUGHIN6¥< -1;- ~ -q I SERVI CE , FINAL
EST,,-~OST ] J()~ PERMIT FEE;;"O~J1LR~-~
REMARKS- --
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