HomeMy WebLinkAbout0123017-Electric
G
OSHKOSH
ON THE WATER
Job Address 1360 FIRESIDE CIR
CITY OF OSHKOSH
No
123017
ELECTRIC PERMIT - APPLICATION AND RECORD
Owner
JEAN R GOGOLlN
Create Date 12/28/2006
Contractor
HOMEOWNER
Category 612 - Residential-Single Family Addition/R Plan
Service
p New
o Change
o Temp
. N/A
Type
o Overhead
o Underground
Amps
Receptacles
5
12
Volts
Circuits 4
Switches 4
Luminaires
Appliances
.
Use/Nature of SFR\ 1 20 amp ckt for bath, 2 ckts for family rm recepts, add sw & replace fixtures in ceiling, 1 20 aqpm ckt for freezer, add 1
Work interconnected smoke del.
$600.00
Plan Approval
$0.00
Permit Fee Paid
$32.00
Fees: Valuation
Issued By:
4~/<
, I .
Date 12/28/2006
D Permit Voided I
Parcelld # 1226910000
The undersigned, in applying for an Electric Permit to perform 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 perform all work pursuant to rules 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 withi an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary ppr vals befor tarting such activity.
Signature
Date
IZ(Z~' ~
Agent/Owner
Address
OSHKOSH
WI 5490 - ~_1J!~ Telephone Number 426-3339
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.
:';,;/1
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone'(920) 236-5050
Fax (920) 236-5084
..~
OJHKOfH
ON THF WATER
f'
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
. Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
nonnal pennit fee, which ever is greater.
OR
Ifvou are a contractor DarticiDatin~ in the Permit Fee Account Svstem and have adeouate funds. check here
ifvou want this Drocessed throu~h vour account D. .,
DATE
t2-(2-7/ ZOot
JOB ADDRESS
OWNER,
13"~ f"\r<1. ,,>iJ. ( C ..'c~_ (iL
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CONTRACTOR S-e (f
CHECK 6!r ALL APPUCABLE
USE CATEGORY
r 01Single Family
. SERVICE DNew
. gtChange
DDuplex
DMulti-Family
ORentaI
DCommercial
o Industrial
OTemporary
DNot Applicable
TYPE DOverhead 'QNot Applicable
DUnderground
FllL IN THE APPROPRIATE BLANK WITH THE NUMBER
f
Receptacles #
~ I!2..
11
Circuits # t--f .
FlXttires # 5
. Volts
:phase
:Amps
Switches #
CHECK fa ALL APPLICABLE
ORange
OFan OR Blower
DMotors
o Dishwasher
OFumace
DGas Pumps
DGarbage Disposal
DAlC
o Other
. .
DDryer OWater Heater
DElectric Sign
-
2-cAMf'
DESCRIPTION OF ALL WORK BEING DONE I C,r<.v.., -Fw
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babl",ru.) --. 2. CW-C t..~ -t" (-~!:t;..~)
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1'1' ALUE (Including labor and all materials including light lIxtures) $
MASTERELECTRICIAN ~." SELF Ov/tJf.L
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