HomeMy WebLinkAbout0024427-Electric (service cable)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
24427
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ADDRESS
PLAN NO.
OWNER
DESIGNER
c~!':'t
USE/NATURE OF WORK
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
,
ELECTRIC CONTRACTOR
Electric Servo New 0 ChangeX Temp
Fixtures Switches
TYPeJ!..itL- Volts';&' ';fCl Amps/&O
Receptacles Circuits
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PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
Permit Fee Paid $ I cJ~- J
Date 7 -- 2;J-- 7 /
Park Dedication $
Final/O.P. 7 - s /.. 9 /
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ISSUED BY
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE
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AGENT/OWNER
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DATE
ADDRESS
wI ...5-5/7c) J
.:133 -.::1 / 7,.""1
TELEPHONE #
AFFIDAVIT RELATING TO SECTION lJ.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
J STATE OF W!SCONSIN)
}SS
; WINNEBAGO COUNTY )
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Name )
, /3)1 ~ 4~; t:Y~
Address) ,
flrst belng du17 sworn on oath, deposes and says that he 1s not
a ~lcensed electr1c1an in the City of Oshkosh and that he has
applied for an electr1cal perm1t to do electr1cal work 1n a
res1dence and/or aux1l1a~ bu11dings (intended solely for pur-
poses associated with a residence) which is owned and occup1ed
07 him, or 1s being constructed in his name, as his personal
home and that sa1d residence or auxiliary bu1ld1ngs be1ng so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Aff1ant understands that the electr1cal work authorized by
the permit app11ed tor 1n connection with this affidavit, must
be done on17 b7 this affiant. and that he cannot employ others to
ass1st with the electr1cal work but memcers of his immediate
family.
Dated this
23
day
o~ ~ ' 1921-
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Subscribed and sworn to before
this
day of
, 19_.
Notary Public, Winnebago County, Wisconsin
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My Commission Expires:
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