HomeMy WebLinkAbout0038928-Electric
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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38928
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ADDRESS $3 w, /LJ PLAN NO.
Ii /11 K4Spe<
OWNER
DESIGNER
USE/NATURE OF WORK (£:F;': )
(¡¿tTCflEN
'RE-WIIlE
Re:.M'oa::£/ÆJ6 )
'ßj{ I srr 1U6
k¡ rCJ-( é9V.
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Class of Const.
Height
Occupancy Permit
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
CJú.J )..)£
Electric Servo /l New 0 Change D,Jemp 0 Type ~ Volts - AmPfi-
Fixtures 0( Switches ..:> Receptacles ------LL Circuits ",;¿
PLUMBING CONTRACTOR
_BT _WH _Disp _WSoft - CBasin
_Lav _Sh _DW _DF - San. Sewer
_WC _FDr _SP _Ur - Storm Sewer
_Sink' _LTub _Eject -SS _Water
Other
/
V '
FEES: Valuation $ /00, c62 ¡D. QP
Permit Fee Paid $ Park Dedication $
ISSUED BY -f~ :; f~ Date t./ J¡ $" jr¡ t.j Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construttion.
SIGNATURE ~ c:v, /é-r--
AGENT/OWNER
7"-/S'-PY
OATE'
ADDRESS
.23>3
Cd IV-H
;}..33-0601
TELEPHONE # "
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AFFIDAVIT RELATING TO SECTION 1},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)
TÞ1 !C~f( cr
(Name
2'S :s Lv, I ~ ^+ì
(Address)
first being duly sworn on oath, deposes and says that he is not
a licensed eiectrician 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 his 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 this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this
/'!;;
day of
Clfr: \
, 19:>"'('-.
/ ~I v.(~~
Subscribed and sworn to before
~~)5:J'~ ,loU,
Notary Public, Winnebago County, Wisconsin
My Commission Expires: 1?/¡r¡/C¡7
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