HomeMy WebLinkAbout0012712-Electric (lower level)
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
12712
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ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Canst.
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System Heat Loss
EL~(;TRIC CONTRACTOR ¥..../
Electric Servo New 0 Change 0 Temp 0 Type - Volts-
Fixtures ~tches ~ptacles ~ircuits
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PLUMBING CONT ACTOR
BTU'S
Amps-
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1JQ~
_WC
_FDr
_LTub
_Dlsp _WSolt - CBasin
_DW _DF - San. Sewer
_SP _Ur - Storm Sewer
_Eject _SS _Water
_BT
_WH
_Sh
_Lav
_Sink
Other
eCJC9Ý-
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Permit Fee Paid $ I)~'
Date Y:--~2S}?
Park Dedication $
Final/O.P.
ISSUED BY
yo,
In the performance of this work I agree to perform ail work pursuant to rules governing the described construction.
4- 't- f;1
DATE
SIGNATURE
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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)
. ) SS
WINNEBAGO COUNTY )
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Name
'.
I
8 J9 Hennessv S+'
(Addrti!ss)
flrst 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 auxiliary- buildings (intended solelY' for pur-
poses associated with a residence) which is owned and occupied
by him, or is being constructed in h1s name, as his personal
home and that said residence or auxiliary- buildings. being 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 permit applied for in connection with th1s affidavit, must
be done onlY' by this affiant and that he cannot employ cthers to
assist with the electrical work but members of his immediate
family.
Dated this
4-+1.-,
day of AFr~ I
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SuQscr1b~"A and sworn to before .
th1s ~.'9ay of (¡(hoD
~,Q9^ ~ .~. f'/\r,J~
,19m..
Notary Public, Winnebago County, Wisconsin
My Commissicn Expires:
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, 19!1..
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