HomeMy WebLinkAbout0027852-Electric (garage)
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CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
27852
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TYPE: BLDG D HTG D ELEC ri'l PLBG D SIGN D ZONING FLOOD PLAIN HEIGHT
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ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR () (PY1.{.A
r
Electric Servo
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New D Change D Temp D Type - Volts _ Amps_
Fixtures
Switches
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: Valuation $ 300. 0"0 Permit Fee Paid $
ISSUED BY ~//"- ~(.4I~:- Date
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34, /71..-
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Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
~~
3 -27--9'L
AGENT/OWNER
DATE
ADDRESS
TELEPHONE #
Iii.
II AFFIDAVIT RELATING TO SECTION 1:3 .12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES .
STATE OP WISCONSIN)
} SS
WINNEBAGO COUNTY )
(?AND Y k05r
(Name
,
623 B/5Mk!(' A J4q.
(Address)
f1rst be1ng duly sworn on oath, deposes and says that he 1s not
a 11censed electrician 1n the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or aux1l1ary bu11d1ngs (intended solely for pur-
poses assoc1ated w1th a residence) wh1ch 1s owned and occup1ed
by h1m, or 1s being constructed in his name, as his personal
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.
Aff1ant understands that the electrical work authorized by
the permit app11ed for in connect1on with this affidav1t, must
be done only by this affiant and that he cannot employ others to
assist w1th the electrical work but members of his immediate
fam11y.
Dated th1s
,.., 7 711
,4 . day of
~
, 19 '7 t.....
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Subscr1bed and sworn to 'before
th1s :z Tfl' day of 'J;J;oJZdL , 191,L.
y/t ~j7 ,[' itl-A-?
Notary ~ublic, W1nnebago County, Wisconsin
M1 COllllD1ssion Expires: r' ~ f9 '1 2_
OWNER
DATE
- ;;-7-7'.7-
PERMI[' NO.:i 1 ~~
ELEC. CONTR.
ADDRESS
< ',NATURE OF WORK
Ii iJ.EC. SERV. NEW
OESC. TYEE
F~X'S ~ SW'S
AEPLIANCES
caANGE
VOLTS
RECEPT'S
k
TEMP.
~S
CIRC'S
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FINAL 0 ~
/ <;" b- DATE PD. ''3 -..2/*
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