HomeMy WebLinkAbout0040362-Electric
~
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
(PI!
Ng 40362
ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
HEATING CONTRACTOR
~
, Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New ~ Change 0
Fixtures Switches
Volt"3t<J Amp!-O?J
Receptacles
Circuits
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: valuatio~ 0 ~ _" Permn Fee Paid $ S-O, €l '" '..
ISSUED BY . ~~ .. <:'./ Date 1 /7,,4 ~
If' ' I
Park Dedication $
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
OA
ADDRESS
TELEPH NE #
PERMIT NO. fa ~tP '-
ELEC. 'CONTR.(~....~
~ltfNER #~ ~~~,
bQDRESS 30 70 ,~J.-?~p~.
Hl'TURE OF WORK
. APPL. DATE
,
~Ir /9 <f'
ft, II
ELEC. SERVo
DESC. TYPE
FIX'S
APPLIANCES
CHANGE
VOLTS
RECEPT'S'
TEMP.
AMPS 00
CIRC'S
SIGNS
INSP. ROUGHIN ~
EST. COST 7.-0 () () ~;) ()
REMARKS
/
\ I
v
SERVICE
PERMIT FEE . D 0
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