HomeMy WebLinkAbout0012426-Electric
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
12426
TYPE:
BLDG 0 HTG 0 ELECß8:( PLBG 0 SIGN 0 ZONING - FLOOD PLAIN- HEIGHT-
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
DESIGNER
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PLAN NO,
ADDRESS
OWNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq, Ft
# Rooms
# Stories
Height
, Occupancy Permit
Class of Const
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
~\
Electric Serv, New 0 Change 0 Temp 0 Type - Volts - Amps-
Fixtures ()( Switches ~ Receptacles !>c Circuits X,
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PLUMBING CONTRACTOR
_BT
_WH
_Sh
_Disp
_OW
_WSoft
_OF'
- CBasin
- San. Sewer
-Lav
_WC
_FOr
-SP
- Eject
_Ur
- Storm Sewer
_Sink
Other
_LTub
_SS
_Water
-ð =---- Permit Fee Paid $
Park Dedication $
Final/O.P.
ISSUED B
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER
Q-~....,-&~
DATE
ADDRESS
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TELEPHONE #
AFFIDAVIT ~ING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH BELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE 0' WISCONSIN)
. ) SS
WINNEBAGO COUNTY )
~ I<cu.}~r
(Name
23'S kJ.l'-\-\\
(Address)
first be1ng du17 sworn on oath, deposes and sa7s that he is not
a ~1censed electrician 1n the C1ty of Oshkosh and that he has
appl1ed for an electrical permit to do electrical work 1n a
res1dence and/or aux1l1a~ bu1ld1ngs (intended solely for pur-
poses associated with a residence) which is owned and occupied
b7 h1m, or is being constructed in h1s name, as his personal
home and that said residence or auxiliary bulld1ngs being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Aff1ant understands that the electrical work authorized by
the permit applied for in connection w1th this affidavit, must
be done onlyb7 this affiant and that he cannot employ others to
assist w1th the electr1cal work but members of his immediate
fam1l7.
Dated this
;27.
day of
r=~,
, 19~.
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",
Subscribeci and sworn to before -
this ;¿1~ da7 of ~~ ' 19.f1' .
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Notar7 Fub11c, Winnebago Count7, Wisconsin
My Commission Expires: 9---~_?' ¡99¿
I '
ÞERMIT NO. !;¿ Lf;;z. ~ . APPL. DATE ;2. -2 ;:' - gy
~LEC. CONTR~ .~~(
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23 ? ~ Lv-/tf~,
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OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVo NEW
DESC. TYPE
FIX'S 0:-- SW'S IX
APPLIANCES
~~~~~ ROUGHIN~; ~~.. '7.9' SERVICE . FINAL
EST. COST ?fe> - PERMIT FEE :¡ ~~ATE PD.
REMARKS -
CHANGE
VOLTS
RECEPT'S
-')'
TEMP.
AMPS
CIRC'SA('