HomeMy WebLinkAbout0125269-Electric
o
OSHKOSH
ON THE WATER
Job Address 424 MERRITT AVE
CITY OF OSHKOSH
No
125269
ELECTRIC PERMIT - APPLICATION AND RECORD
Owner
COREY M DOMKE
Create Date 06/11/2007
Contractor
HOMEOWNER
Category 612 - Residential-Single Family Addition/R Plan
Service
o New
o Change
o Temp
. N/A
Type
o Overhead
o Underground
Amps
Switches 3
Receptacles
6
9
Volts
Circuits
Luminaires
Appliances
UselNature of FR\ Wiring bathroom and dining room according to current code.
Work
I
~
$25.00
Fees: Valuation
$500.00
Plan Approval
$0.00
Permit Fee Paid
Issued By:
4Jtd
Date 6/11/2007
o Permit Voided I
Parcelld # 0404430000
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
h~lder(S) and to se~any nec. es~ approvals before starting such activity.
Signature ~----J'" _.U~.~ Date 0-::/"'-07
( Agent/Owner
Address c~~?<1 ~Y;/l :f!"
OSHKOSH
WI 5490 - 5046
Telephone Number p:YS-c;70~"->
To schedule inspections please call the Inspection Request line at 236.5128 noting the Address, Permit Number, Type of
Inspection (Le. 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 ofInspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone-(920) 236-5050
Fax (920) 236-5084
~
OJHKOfH
ON THF 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 t~ Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without pennit(s) will result in fees being doubled or $100.00 plus the
nonnal pennit fee, which ever is greater.
OR
Ifvou are a contractor participatinf in the Permit Fee Account Svstem and have adeouate funds. check here
ifvou want this processed throuf!h vour account D. -
DATE 6--/I--C7
JOB ADDRESS ,,/PI ~rY'/1I ~
d - .
..:::~~1 ~::~
CHECK ~ ALL APPUCABLE
USE CATEGORY
CSingle Family DDuplex
DMulti-Family
DRental
o Commercial
DIndustrial
SERVICE DNew
DChange
DTemporary
DNot Applicable
TYPE OOverhead
DUnderground
DNot Applicable
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
- Volts /~ I
:rhase
Amps
t
Receptacles #
7/J
I/;
Circuits #
Switches #
FlXt1ires #
y/:?
CHECK ~ ALL APPLICABLE
ORange
DFan OR Blower
OMotors
DDishwasher
OFumace
OGas Pumps
DGarbage Disposal
DAlC
DOther
ODryer DWater Heater
OElectric Sign
DESCRIPTION OF ALL WORK BEING DONE
?-t//!/Jhy
&-r:?o/ v''Y;,.;v,..,.,.., 2~,/'I/
. J
/:..</./-; -/i#
_ - VALUE (Including labor and all materials including light f"Ixtures) $ j v
MASTER ELECTRICIAN ~-;? ~~
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3/02