HomeMy WebLinkAbout0090812-Electric
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OSHKOSH
ON THE WATER
Job Address 3095 HUNTERS PL
CITY OF OSHKOSH
No 90812
ELECTRIC PERMIT - APPLICATION AND RECORD
o Change
Owner MILTON/MELISSA SCHIERLAND ,Create Date 09/21/2001
Category 612 - Residential-Single Family Addition/R Plan
o Temp Type o Overhead o Underground
Circuits Fixtures
Switches 3 Receptacles 5
Contractor D&A ELECTRIC
Service
b New
Volts
Amps
Appliances
Use/Nature of SFR/ Wire addition.
Work
Fees: Valuation
$495.00
Plan Approval
$0.00
Permit Fee Paid
$20.00
Issued By:
KV'I'
Date 10/25/2001
o Permit Voided I
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address
POBOX 258
DALE
WI 54931 - 258
Telephone Number (920) 851-5920
o!"
~
OJI-KOJR
ON THE WATER
Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903-1130
Fax (920) 236-5084
Phone (920) 236-5046
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
DATE
ill - 2. ?.-Ol
JOB ADDRESS 309s- /lUJuT&.t2.S PUJ-G'L-
OWNER /h~LISSA
CONTRACTOR
CIRCLE ALL APPLICABLE
USE CATEGORY SINGLE FAMILY
DUPLEX
MULTI-FAMILY RENTAL COMMERCIAL INDUSTRIAL
TEMPORARY ~
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P4
SERVICE NEW
CHANGE
TYPE
OVERHEAD
UNDERGROUND
NO. OF FIXTURES I
I
AMPS
VOLTS
RECEPTACLES S-
PHASE
CIRCUITS
SWITCHES
CHECK ALL APPLICABLE
RANGE
WATER HEATER
GARBAGE DISPOSAL
DRYER
DISHWASHER
FAN OR BLOWER
FURNACE
A/C_
ELECTRIC SIGN
MOTORS
GAS PUMPS
OTHER
DESCRIPTION OF ALL WORK BEING DONE
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. Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.
VALUE
(Including labor and all materials including
ELECTRICIAN PO ll\.;r.;:a R~ ~
light fixtures) $
If crs-: 00
MASTER
PfRmrt Ff;:E. $20.00
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