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OSHKOSH
ON THE WATER
Job Address 1335 JUDY LEE CT
CITY OF OSHKOSH
No 123687
ELECTRIC PERMIT - APPLICATION AND RECORD
Owner
GEORGE M1MELlSSA F KALKA
Create Date 03/05/2007
Contractor
HOMEOWNER
Category 612 - Residential-Single Family Addition/R Plan
Service
b New
o Change
o Temp
. N/A
Type 0 Overhead
o Underground
Volts
Amps
Circuits
Luminaires
Switches
Receptacles
8
Appliances
Use/Nature of SFR\ Basement remodel according to current code.
Work
u ~~ c<':T~~ ._~
Issued By:
41/2
$1,000.00 Plan Approval
eM/( rr-
$0.00
Permit Fee Paid "$60.00
Fees: Valuation
Date 3/5/2007
D Permit Voided I
Parcelld # 1343730000
The undersigned, in applying for an Electric Permit to perform electrical work within a single family home, owned and occupied
as the principle residence by the undersigned; hereby acknowledges per City Municipal Code Section 11-22, that other
individuals may not be employed to assist with the work described in this permit unless said individuals are licensed by the
City of Oshkosh to perform said work.
In the performance of this work I agree to perform all work pursuant to rules goveming the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity. I /
Signature ~ It:--- Date ~ r,'2 007
r AgenUOwner
Address
OSHKOSH
WI 5490 - 0000
Telephone Number
To schedule inspections please call the Inspection Request line at 236.5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
. "~
.. City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone'(920) 236-5050
Fax (920) 236-5084
~
OJHKOfH
ON THF WATER
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
. Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without pennit(s) will result in fees being doubled or $100.00 plus the
nonnal permit fee, which ever is greater.
OR
Ifvou are a contractor DarticiDating in the Permit Fee Account Svstem and have adeouate funds. check here
ifvou want this Dracessed tkroueh vau;. account D' ,
DATE 3! s- !-LQ{)7
JOB ADDRESS \, .~ r J vO'f Lff [O(,I,ll
OWNER, G0J~t:..L ~frLr-*
CONTRACTOR C-ll'12,a: \Hct--in~ 4 ILfftlL"'\ rA-cv~t-
CHECK Ltf ALL APPUCABLE
~ CATEGORY
/~Single Family DDuplex OMulti-Family
. SERVICE, ~ew DTemporary
DChange DNot Applicable
ORental
OCommerciaI
DIndustriaI
TYPE OOverhead
DUnderground
DNot Applicable
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
I
'Receptacl~ # B
Switches # S-
Circuits #
. Volts
.:phase
AmPs
FixtUres #
CHECK g ALL APPLICABLE
ORange '
~an OR Blower
OMotors
DDishwasher
DFumace
OGas Pumps
DGarbage Disposal
DAlC
DOther
DDryer OWater Heater
DElectric Sign
DESCRIPTION OF ALL WORK BEING DONE
~WOO(A:... Df- P71~~NT
IJ';,
.' VALUE (Including labor and all materials including light f"u:tures) Lt 6M.,.....-
MASTER ELECfRICIAN G toile'll. tA-crlT
tM-1~
3/02