HomeMy WebLinkAbout001886-Electric (service change)
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CITY OF OSHKOSH Ng
PERMIT - APPLICATION AND RECORD
01886
TYPE: BLDG 0 HTG 0 ELEC $I( PLBG 0 SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
OWNER
?;;Z3-6~
C~~ ~ ?Yl c/CK)
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
_/1' ?/
.
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Fixtures
New D c~ange)<( Temp D Type}';;;:: Volts IZ:! ",0 Amps /c:lCl
Switches Receptacles " Circuits t2f ~___
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
PLUMBING CONTRACTOR
_BT
_WH
_Sh
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_Lav
_ San. Sewer
_WC
_FOr
_ L Tub
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
'1 t::.;""A~
FEES: Valuation $ ..t- v V
ISSUED BY ~~
/
/ t3 (/ v"
Permit Fee Paid $ c?-- ~
Date / / - If - 3--6
Park Dedication $
Final/O.P. ~ -.,) "'?7
/
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE a,~}) d Y1~
II~ b --8b
AGENT/OWNER
DATE
ADDRESS '8 J- 3 '~i S fvtAJlc Ie
/; 35- Us J )
TELEPHONE #
. '
AFFIDAVIT RELATING TO SECTION 13..12 (c) OF A GENERAL ORDINANCE
OF TEE CITY OF OSHKOSH RELATING TO THE LICENSING OPELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
W'INNESAGO COUNTY )
'-
'M/liPIt/ I ~ /l1tJ!i5
( Name )
,
cf,) 3
[3/5/Vll1fZc/c
(Address)
f1rst be1ng duly sworn on oath, deposes and says that he 1s not
a l1censed electric1an 1n the City or ,Oshkosh and that he has
app11ed ror an electrical pe~lt to do electrical work in a
residence and/or auxi11ary bu1ldings (intended solely for pur-
poses assoc1atedw1th a residence) wh1ch 1s owned and occupied
by him. or is 'being const1"\1cted in his name, as his persoZU1l
home and that said residence or auxiliary bUildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
the permit applied for in connection With this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family..
Dated this
7h
6
day of tlrw
, 19~.
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Subscr1bed and sworn to before
this 0'i:!1day of Y7y~
~., .
a(),~O.Q~. \. rftl/LM~
Notary Public, Winnebago County, Wisconsin
My Comm1ssion Expires: g/s-/q{)
, 19~.
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SIGNS
INSP. ROUGHIN
EST. COST
REMARKS
DATE I/--~ -g~
PERMIT NO. ~ ('I :J (-;
ELEC. CON'!'R.
OWNER
_l-L/
TEMP.
AMPS 0 CJ
CIRe's
SERVICE '
PERMI'!' FEE