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OSHKOSH
ON THE WATER
Job Address 103 W 15TH AVE
CITY OF OSHKOSH
No
123872
ELECTRIC PERMIT - APPLICATION AND RECORD
GERALD M/JILL L STANUCH
Create Date 03/21/2007
Owner
Contractor
HOMEOWNER
Category 612 - Residential-Single Family Addition/R Plan
Service
b New
o Change 0 Temp
. N/A
Type 0 Overhead
o Underground
Volts
Amps
Circuits
Luminaires
2
1
Switches
2
Receptacles
Appliances
ydromassage tub{9.2 amp), exhaust fan.
Use/Nature of SFR\ Wiring for new bathroom.
Work
Fees: Valuation
4
Issued By: 4-fVJ:-
$500.00
Plan Approval
$25.00
$0.00
Permit Fee Paid
Date 3/21/2007
D Permit Voided I
Parcelld # 0304950000
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 governing 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 ces ry pprovals be ore starting such activity.
Signature
Date ~ ~z/-1)7
Agent/Owner
Address ( 0 5 (,v I J-f_tLb OSHKOSH
WI 5490 - 6511 Telephone Number 920-233-0630
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, VV154903-ll30
Phone (920) 236-5050
Fax (920) 236-5084
~
OJHKOfH
ON THE 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 permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If vou are a contractor particivatine in the Permit Fee Account Svstem and have adeQuate funds. check here
if vou want this vrocessed throueh vour accou!,/t D
DATE ?-.- 21 - 0 7
JOB ADDRESS 10 3
6- et-ra( c/
OWNER
CONTRACTOR /f/ A
W. /5 f~ A ve i
Sf Cllh v(,~
CHECK 0 ALL APPLICABLE
USE CATEGORY
p(Single Family
SERVICE DNew
DChange
DDuplex
DMulti-Family
o Rental
DCommercial
Dlndustrial
o Temporary
DNot Applicable
TYPE DOverhead
DUnderground
DNot Applicable
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts
Phase
Amps
Circuits # J
Fixtures # 2
~ J~V{.t.for7 I~f
- fer P1 /1r.Jh f
I
Receptacles # _I
Switches # 2. U~vA.ff / 1411 )
20
I Z '~()JfI- G Fe T
CHECK 0 ALL APPLICABLE
DGarbage Disposal DDryer DWater Heater
DAlC DElectric Sig1 ( )
OOther h "jvo mq~f'UJL . b&'tfh Iii 1.2. ~rnl.1:!7
I /
DESCRIPTION OF ALL WORK BEING DONE n e.. IV it, tL i h VD () 111 Iv; j/' " Ylt')
J
ORange
DFan OR Blower
DMotors
DDishwasher
DFumace
DGas Pumps
VALUE (Including labor and all materials including light fixtures) $ S" 00
MASTER ELECTRICIAN J1I1f _~ ~
3/02