HomeMy WebLinkAbout0025936-Electric (service change)
~
CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
25936
TYPE: BLDG D HTG D ELEC ~ PLBG D SIGN D ZONING FLOOD PLAIN HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - ;- - ~ - - - - - - - - - - - - - - - - - - - - - - - - -
f; I ~ - 0J1'J~ PLAN NO.
(~- ~V' .o/k/,-
t7
~L~A~P' ~~ ,
<..- ~7 5-~tP 2& ;>~/OcJ
r -
ADDRESS
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const.,
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR . #
Electric Servo New D ChangeKTemp D Type~
Fixtures Switches Receptacles
Volts j;}SlO Amps I" ()
Circuits
~r
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _LTub _ Eject _SS _ Water
Other
/
~t!J/c1 ~. ". ~ -do 'r
FEES: Valuation ~ Permit Fee Paid $ .- ..> ~
ISSUED BY Date / ~ - ,;2-..;)- -7/
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 t;::; (5, ~~ (\)'d"'>-~'(
AGENT/OVYNER DATE
ADDRESS /'1 <; d I SLV' S-r. .)3:'- '{)/~
TELEPHONE #
!.
AFFIDAVIT RELATING TO SECTION 13.12 (0) OF A GENERAL ORDINANCE
OF TEE CITY OF OSHKOSH BELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
} SS
WINNEBAGO COUNTY )
<<
..
-s () ~~ Lh€...C'... 'b \.)
(Name )
J
SI'1 f\c.J.,".<..oV' ~T-'
(Address)
.,
f1rst oe1ng duly sworn on oath, deposes and says that he 13 not
a lioensed electriolan 1n theC1ty of Oshkosh and that he has
applled tor an eleotrloal perm1t to do electr1cal work ln a
-res1dence and/or aux1llary bul1d1ngs (1ntended solely for pur-
poses assoc1ated with a residence) wh10h is owned and occupied
oy hlm, or 1s being construoted 1n his name, as h1s personal
home and that sald res1denoe or auxiliary bu1ld1ngs be1ng so
wired are not to be used or erected tor rental purposes or for
resale to present or prospect1ve purchasers.
Afflant understands that the electr10al work authorized by
the perm1t app11ed for 1n oonnect1on with this affidavit, must
be done only by this aff1ant and that he oannot employ others to
ass1st with the electr1cal work but members of his 1mmed1ate
faml1y.
;r.
Dated this
d- d-~.2. day of
o c.-t-~ b (.,,,
, 19.:1.L.
~
f:>~ ~A{
'I
Subscr1bed and sworn to before
"this :i;.~ day of (T)cr~ , l~( .
'm71rT /( ~
Notary ~ublict W1nnebago County, W1scons1n
M;l" Comm1ss1on E.l:p1res: Q...... 5 1''19' ~
(/ .
.,)
'D/
ADDRESS
NATURE OF WORK
DATE Id ~ 2.2-}1 ('
'i:/.-';
PERMIT NO.
ELEC. CONTR.
OWNER
S"/~-~~
EC. SERVo
DESC. TYPE
FIX'S
APPLIANCES
SI'GNS
INSP. ROUGH N
EST. COST
REMARKS
CHANGE
-.iV VOLTS I
RECEPT'S
TEMP.
AMPS r-CJ
CIRC'S
SERVICE~ ... -
PERMIT FEE
. "........, I....." .'C..,,,.... 'h "':'-' ....,' .... ..-. '" '. .'
I