HomeMy WebLinkAbout0014188-Electric
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CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
14188
OWNER
DESIGNER
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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
ELECTRIC CONTRACTOR /
Electric seN.ci\NeW~hange 8(.' ~emp D TYP~Volts !~. ,/-Olynps2tJO'
Fixtures , Switches Receptacles .-- Circuits~
V~~
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
OC-
------permit Fee Paid $
Date
7
7,) ~l
6-;z.9~69
/
Park Dedication $
Final/O.P. jJ - J '- '87
ISSUED BY
,f
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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DATE '
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TELEPHONE #
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AFFIDAVIT RELATING TO SECTION1J.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 )
---:C:N t~LA'~OWL-
(Name _
J
'>:?ot:;'
/!;A Vi'+tlj/tv ('JT~
(Address)
first being duly sworn on oath, deposes and says that he is not
a l1censed electr1clan 1n the C1ty of Oshkosh and that he has
app11ed for an electr1cal perm1t to do electr1cal work in a
residence and/or aux1l1ary bu1ld1ngs (1ntendedsolely for pur-
poses associated w1th a res1dence) wh1ch is owned and occupied
by him, or 1s being constructed 1n his name, as his personal
home and that said residence or auxiliary bu1ld1ngs being so
w1red are not to be used or erected for rental purposes or for
resale to present or prospect1ve purchasers.
Aff1ant understands that the electr1cal work author1zed by
the permit applied for in connect10n w1th this affidavit, must
be done only by this affiant and that he cannot employ others to
assist w1th the electr1cal work but members of h1s 1mmed1ate
family.
Dated th1s :;;,771-1 day of - ...JON (;1
, 19 8r.
-
th1s
day of
, 19__
Subscr1bed and sworn
Notary Public, Wlnnebago County, W1sconsln
M1 Commiss1on Expires:
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i!JvJ9f?2~
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PERMIT NO.
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DATE~ ';2;/-%
E C. CONTR.
OWNER ~~ ~~e
l\DDRE~S {/ /::4tJ -~. ",2/
NATURE OF WORK - - /' t'""'---