HomeMy WebLinkAbout0001077-Electric
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CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
01077
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ADDRESS Z1 . ~~
OWNER . ~ ~~
PLAN NO.
DESIGNER
~~~~
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
.\'.t
/..;?O l- <M /e>- .... 0 ?'V
Electric Servo New D Change D Temp D Type _ Volts Amps _0 ' .
Fixtures X Switches ~ Receptacles Y' Circuits )("'
, ELECTRIC CONTRACTOR
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
FEES, valualiO~ 6~ Perm " Fee Pmd $
ISSUED BY ~ Date
50 <J3 ~/
g-..z-r- ~
Park Dedication $
Final/O.P.
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In the performance of this work I agree to perform all wor pursuant to rules governing the described construction.
SIGNATURE
DATE
ADDRESS
TELEPHONE #
PERMIT NO. CJ
ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVe
DESC. TYPE J
FIX'S
APPLIANCES
TEMP.
AMPS c;JO
CIRC'S ><
o FINAL<7~q-&'t
DATE PD.8':n-ffb