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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
06956
TYPE:
BLDG D HTG D ELEC ~ PLBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
::N:E:~ - - - - - - - - - - - - i~~- o~ - - ~~~ ~~- - - - - - - - - - -
DESIGNER
~~-~,
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
. Heat D AlC D Vent D Fuel/System Heat Loss
~'/
ELECTRIC CONTRACTOR ~ f
Electric Servo New D Change D Temp D ype _ Volts_
Fix,",es c><.. Switches ~~s, ~ Ci'c"its
BTU'S
Amps_
ex- ~ /
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer ~
l
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
ISSUED BY
~-- .~7'/
Permit Fee Paid $ 2 (J
Date 2 -3 - f) g:-
Park Dedication $
Final/O.P. ..3- 2 ~ - a s
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
.......'-<
SIGNATURE ~ :?/'~
AGENT/OWNER
;2 -"3 -.P?
DATE
ADDRESS
/710 tf;J --et?/Y"~-IJ
{2T
d-3/-~OI.J-
TELEPHONE #
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AFFIDAVIT RELATING TO SECTION 13.12 (0) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING 1'0 THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
lit?
"
-
~-'-E(/E WISS/~k.
( Name )
, 1?'70
O~{!H-4R.D Cr:
(Address)
f1rst being duly sworn on oath, deposes and says that he 1s not
a l1censed electr1c1an 1n the City of .Oshkosh and that he has
applied for an electrical permit to do electr1cal work in a
residence and/or auxiliary buildings (intended solely for pur-
poses assoc1ated w1th a residence) which 1s owned and occup1ed
by him, or is being constructed 1n 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 w1th this aff1dav1t, must
be done only by this affiant and.that he cannot employ others to
assist w1th the electrical work but members of his immediate
familY' .
Dated this
d
3
day of
f:~A/1AH1
~#" ?/-~
, 19.,&E.
Subscribed and sworn to before
thl's J$- _ d.ay of 'jlliJu"'"tI ' 19&.
~~J- ~ r\;\J~~~
.,
Notary Public, Wlnnebago County, Wisconsin
My Commission Expires: g/5/;qq()
f,,,,
PERMIT NO. V it:? 56
ADDRESS
NATURE OF WORK
7cJ ~
~/~~.
CHANGE '1'EMP. .
VOLTS AMPS
9 tV C>Z.:aECEPT' S ~. CIRe's. 0" .
/9~~,
ELEC. co TR.
OWNER
~LEC. SERV. NEW
DESC. TYPE
FIX'S ex-
APPLIANCES