HomeMy WebLinkAbout0004743-Electric (service change)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
04743
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DESIGNER
PLAN NO.
ADDRESS
OWNER
USE/NATURE OF WORK
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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
Electric Servo New D changeKTemp D TYP~
Fixtures Switches Receptacles
~.
Circuits
,""PS~ ~
PLUMBING CONTRACTOR
_BT
_WH
_Sh
_ San. Sewer
_WC
_FOr
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
~ _ Lav
_Ur
_ Storm Sewer
,:",;,
_Sink
Other
_ L Tub
_ Eject
_SS
_ Water
FEES: Valuation $
ISSUED BY
. I
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Permit Fee Paid $ ~V 'I
Date 7-;Z% -0'7
,. . ,
Park Dedication $
Final/O.P. ;(...(., - fl
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~ <f~
AGENT/OWNER
ADDRESS jJ.;'tJ /{/~'" ,~
~AT(!-t;/7
i31-FCi/
. TELEPHONE #
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AFFIDAVIT ~ING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSEXOSH BELATING TO THE LICENSING. OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
} SS
WINNEBAGO COUNTY )
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. (Addre ss '
first being duly sworn on oath, deposes and says that he is not
a licensed electrician in the Clty of .Oshkosh and that he has
applled tor an electrical permit to do electr1cal work 1n a
residence and/or aux1l1arybul1dlngs (1ntended so~ely for pur-
poses associated w1th a residence) whlch 1s owned and occupled
by him, or ls 'being constructed 1n his name, as hls personal
home. and that sald residenc.e or aux111ary bulldlngs be 1ng so
w1red are not to be used or erected tor rental purposes or for
resale to present or prospect1ve purchasers.
Af:f1ant understands that the electrical work authorized by
the perm1t applied for 1n connection w1th this atfld.av1t, must
be done only by th1s aff1ant and that he cannot employ others to
ass1st wlth the electr1cal work 'but members of his immediate
fam1ly.
Da ted thl s !J-u~~ ;;.. 51 day of
? y
, 19 87.
Subscr1bed and sworn
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t ~is o<od.ay of
.c;})J\Qp/<LL r
~~~
to before
~~. ,19n.
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Notary Public, Winnebago County, W1scons1n
My Comm1ss1on Exp1res: 8!~/Jqq~
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SIGNS
INSP. ROUGHtN
EST. COST
REMARKS
DATE 7->o--gl
PERMIT NO.V 'i 7 1/
ELEC. CONTR.
.
OWNER
"";",ADDRESS
NATURE OF WORK
NEW
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TEMP.
AMPS .c!JO
CtRC.S
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