HomeMy WebLinkAbout0091416-Electric (service change)
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OSHKOSH
ON THE WATER
Job Address 2470 HICKORY LN
CITY OF OSHKOSH
No 91416
ELECTRIC PERMIT. APPLICATION AND RECORD
Owner MICHAEL D / MELANIE J VANDENBERG Create Date 11/19/2001
Contractor HOEHNE ELECTRIC
Category 634 - Residential-Service Change Plan
Service
p New
. Change
o Temp
Type 0 Overhead
. Underground
Volts 240
Circuits
Fixtures
Amps 100
Switches
Receptacles
Appliances
---.---.,----..~----i
Use/Nature of INew underground service.
Work
Fees: Valuation
$850.00
Plan Approval
$0.00
Permit Fee Paid
$40.00
Issued By: lzV'Y\-
Date 11/20/2001
D Permit Voided!
In the performance of this work I agree to perform all work pursuant to rules governing the desCribed construction.
Signature
Date
Agent/Owner
Address
621 E ONTARIO ST
OMRO
WI 54963 - 0
Telephone Number (920) 685-0199 M 920-42C
~
~OjH
HE WATEII
Divieio~ of Inspection Services
215 Chur(:h Avenue
P.O. Box in-o
Oshkosh, WI 54903-1130
Fax J920l 236-5084
Phone .(920l236-S046
V~f:Mtef~t-
~ ~6VV\AL(fJ,yJ-
OWNER
CONTRACTOR
ELECTRICAL ~RMI-TAnliI-eA'T:r-oN
All information after bold categories must be provided.
Tncompleteapplie~-wiH; '-not-be lhoceseed.
DATE~'1-<J r
CIRCLE ALL APPLICABLE
USE CATEGORY StNm.E --FAMi'LY
'-NEW
-MUL-TI~FAMli:;;YRENTAL-eeMMERCIAL INDUSTRIAL
SERVICE
.TEMPORARY
,NOT APPLICABLE
NO. OF FIXTURES
AMPS-lDO--
SWITCHES
VOL'TS~
NOT APPLICABLE
RECEPTACLES CIRCUITS
PHASEJ
TYPE
OVERHEAD
CHECK ALL APPLICABLE
RANGE
-wA'I'ERHEATER
-GARBAGEDISP.o~
-DRYER
DISHWASHER
u-FAN '-GR. -BLOWBR_
A/C_
ELECTRIC SIGN____
. Submit payment 'With . applrcati-on. Failure to '~'-w.it:h:in '.30days'Wiil result --in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.
VALUE (Including
di#g light fixture~) $ 'l' 6tJ .DO
KASTER BLBC'l'RJ:CZ
TOO~
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