HomeMy WebLinkAbout0022631-Electric (garage)
~
CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
22631
TYPE: BLDG 0 HTG 0 ELEC M PLBG 0 SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
- ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
OWNER
?7"3-~
?n~ .. /./d'L
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
lA/~~
V
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
Fixtures
#J
New 0 Change 0 ~ Type - Volts_
~. Switches eceptacles L><-circuits
ELECTRIC CONTRACTOR
Electric Servo
Amps_
C?"---
~
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _LTub _ Eject _SS _ Water
Other
ISSUED BY
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 ~ \)tJ~ 3- )S~ c:r I
AGENT/OWNER DATE
ADDRESS <6 113 B 15 m<fr~ d.3-S- ~ 13S
TELEPHONE #
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE .
OF THE CITY OF OSHKOSH BELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
1;-
e.
.
STATE OF WISCONSIN)
} SS
WINNEBAGO COUNTY }
~'J\ W lJlrc
(Name )
,
ri ~3 $lS7YleV'ch'
(Address)
first being duly sworn on oath, deposes and says that he 1s not
a 1icensed electrlcian ln the Clty of Oshkosh and that he haS
applled for an electrlcal permlt to do electr1cal work 1n a
resldence and/or aux111ary bulld1ngs (lntended solely for pur-
poses assoclated w1th a resldence) wh1ch ls owned and occup1ed
by h1m, or 1s belng constructed ln h1s name, as his personal
home and that sald resldence or aux1liary bu1ldings be1ng so
W1red are not to be used or ereoted for rental purposes or for
resale to present or prospect1ve purchasers.
Affiant understands that the eleotrlcal work authorlzed by
the perm1t applied tor 1n oonnectlon w1th this aff1dav1t, must
be done only by thls afflant and that he cannot employ others to
assist wlth the electrlcal work but members ot h1s 1mmediate
fam1ly.
Dated th1s /5 day of ftl41'ch
~j '"
~ J-' wJle
.. _w_ .._. .~. ._
., Subscr1bed and sworn to before
th1s day of , 19_-
, 19 '11 .
-..
..~
Notary Public, W1nnebago County, W1scons1n
*7 Commiss1on Exp1res:
=
E'LEC. CONTR.
O~EB.
A12DRESS
NATURE OF WORK
TEME .
~S
C'!RC'S
:
E'LEC. SEB.'!.
DESC. TYPE
F'!X'S SW'S
~PL!~CES
S!'GNS
J:NSP. RO~ SERV'J:cE ;'J:NAl.
~?~~~D~E PD2~1 .~: