HomeMy WebLinkAbout0014203-Electric
~
CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
14203
~~P_E~ _ _ ~L~~ _~ _ ~T~ _ ~ _ ~~E~ P1 ~~B~ _ C? _ ~I~~ _~ _ ~O_N~N~ _ _ _ _ _ _ _F~~~D_ ~L~I~ _ _ _ _ _ _ ~~I~~T_ _ _ _ _
/YLfS- d~~
'~ ~ ~,
'. ~~
lA/~ ~~~
ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELI::CTRIC CONTRACTOR
· Electric Servo NewCQ( Change D Temp D ype. 'It/' Volts I h t.!'OAmps.,;::(&O
Fixtures ~ Switches 0" Receptacles ~..., Circuits ~
)
UX2~
PLUMBING CONTRACTOR
! ,_Sink
-,.. '
_FOr
_LTub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_BT
_WH
_Sh
_ San. Sewer
_Lav
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
Other
ISSUED BY
o
Od~
Permit Fee Paid $
Date
25S~
t6 -~9-ff9
"
Park Dedication $
Final/O.P.
f{--;l7 po 87
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Y ~~l~(\~b
AGENT/OWNER
A~PRESS bD:J.. ~OJ:1 ~CV\ On~~1 \k)[.
54Qo I
q~~,}ql m~
LtR6 - ~
TELEPHONE #
~
AFFIDAVIT RELATING TO SECTION 13.12 (e) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH BELATING TO THE LICENSING OF ELECTRICIANS
'" AND PROVIDING PENALTIES
STATE OF WISCONSIN)
} SS
WINNEBAGO COUNTY )
~\\~\ ~~~N.b
(Name )
., \M5. o1J\UJ\~ f11V '
, Address
f1rst be1ng duly sworn on oath, deposes and says that he 1s not
a llcensed electr1c1an 1n the C1ty of Oshkosh and that he has
app11ed for an electr1cal perm1t to dO electr1cal work 1n a
res1dence and/or aux1l1ary bu11d1ngs (intended solely for pur-
poses assoc1ated w1th a res1dence) wh1ch 1s owned and occup1ed
by h1m, or 1s be1ng constructed 1n h1s name, as h1s personal
home and that sald res1dence or auxl~lary bu11d1ngs be1ng so
w1red are not to be used or erected tor rental purposes or for
resale to present or prospectlve.purchasers_
Aff1ant understands that the el~ctrical work authorized by
the permlt app11ed for in cormect1onw1th this aff1dav1t, must
be done only by th1s aff1ant and that he cannot employ others to
ass1st w1th the electr1cal work but members of h1s1mmed1ate
,fam1ly_ .
Dated th1s ~ day of . : ~ lAJ\<Ll.-
~A!I,~, ~
!
, 19.tl.
~
;
S..."bS"~:J. and SW01"nc! .~~fore I
7i1~ ;f,daf!~ · 1911:..
n . i
Notary Publlc, W1rmeb~ County, W1s~ons1n
M7 Commlss10n Exp1res: '~1..t67PCf 9 ~
(/ /
,j
ADDRESS
NATURE OF WORK
.-
/ --- -") Cj -- :? q
DATE ~ r-/ /
PERM!T NO.
ELEC. CONTR.
OWNER
J.