HomeMy WebLinkAbout0043613-Electric (temp only)
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
(PO} ~
N!- - 43613
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ADDRESS liz'if /lie a.~ PLAN NO.
OWNER ~/~-'f.J..llr ~
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Cons~.
HEATING CONTRACTOR
Heat 0 AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR tJu4?1:.~r-
Electric Servo New D Change 0 Temp K' Type 0111- Volt;"3 W Amps/trY
Fixtures Switches 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
/
V'
FEES: Valuation $ 7 S.~ Permit Fee Paid $ I () d!l 0 .
ISSUED BY ~. ~~ Date //2-7195/
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
DATE
ADDRESS
TELEPHONE #
PERMIT NO. t/.. 3 (p 13 . APPL. DATE o/6/ff.;j
ELEC. CONTR. ~
OWNER ,2)~~
ADDRESS lYz-r me a:~
NATURE OF WORK
fa/~7
ELEC. SERV.
DESC. TYPE
FIX'S
APPLIANCES
NEW
e
SW'S
CHANGE
VOLTS
RECEPT'S '
AMPS,
CIRC'S
SERvr CE -g:; s;- F rNAL
PERMIT FEE DATE PD.
SIGNS
INSP. ROUGHIN
EST. COST
~KS