HomeMy WebLinkAbout0039944-Electric
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
folt
39944
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ADDRESS Is- 3 0 ~8 iLt.JJ.r;J Cd-
OWNER I<eLH.~ 9~
PLAN NO.
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
e
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
p
Heat Loss
BTU'S
ELECTRIC CONTRACTOR IJ {L/H .fA
Electric Servo New~ Change 0
Fixtures ~ches
Temp 0
fr~
Type 6; VOlts3 vJ Amps ~ ()
.,--- Receptacles
.;:--
Circuits ---
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
Park Dedication $
ISSUED BY
Final/O.P.
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
~~;/C91
DATE
ADDRESS
Lfdlc-lj37
TELEPHONE #
-.
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AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) 5S
W INNEBAGO COUNTY )
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' (NPme
,
/530 ~ or-
Addre )
f1rst be1ng ~u11 sworn on oath, deposes and says that he 1s not
a l1censed electric1an 1n the C1ty of Oshkosh and that he has
app11ed tor an electrical perm1t to do electrical work 1n a
residence and/or auxiliary buildings (intended solely for pur-
poses assoc1ated with $ res1dence) which is owned and occup1ed
by him, or 1s being constructed in his name, as h1s personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected tor rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
the permit applied tor in connection 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 immed1ate
family.
Dated this
13 day of .jwt..f
,19ft..
Subscribed and sworn to
~U,4
.~ if
before.
this
day of
_, 19_-
Notary Publ1c, W1nnebago County, Wisconsin
My Commiss1on Expires:
,.J
ELEC.
. APPL. DATE
(1;//3/9 Y
.
PERMIT NO.
,,','j~:.;.<"ii., ;"c."";>,>:....,..,,,
pWNER
ADDRESS I S- 30
~NATURE OF. WORK
ELEC. SERVo NEW
DESC. TYPE
FIX'S SW'S
APPLIANCES
CHANGE
VOLTS ~ uJ
RECEPT'S
=~
CIRC'S
SI"GNS
INSP. ROUGHIN
EST. COST
REMARKS b1~
~~&~
:e.u~ 9f . ....
SERVICE
PERMIT FEE
FINAL I
DATE PD.
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