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OSHKOSH
ON THE WATER
Job Address 226 HIGH AVE
CITY OF OSHKOSH
No 92123
ELECTRIC PERMIT - APPLICATION AND RECORD
Owner
MERIL YN R SMITH
Create Date 03/28/2001
Contractor
SECKAR ELECTRIC
Category 612 - Residential-Single Family Addition/R Plan
Service
o New
o Change
o Temp
Type 0 Overhead
o Underground
Volts
Circuits
Fixtures
Amps
Switches
Receptacles
Appliances
Use/Nature of SFRI Replaced light fixture in association with kitchen & bathroom remodel.
Work
Fees: Valuation
$200.00
Plan Approval
$0.00
Permit Fee Paid
$20.00
Issued By: f<JM
Date 01/08/2002
o Permit Voided I
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
AgenUOwner
Address
5920 COURTNEY PLUMMER ROAD
WINNECONNE WI 54986 - 0
Telephone Number (920) 582-4909 M 379-68~
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Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903-1130
Fax (920) 236-5084
Phone (920) 236-5046
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will hot be processed.
JOB ADDRESS ;}d. ft, Jh 0 1-1 ltVE
OWNER J;.KJ ~-fi. :s CO tJ S# U C I J 0 rV
CONTRACTOR SEe j: AfC-
DATE JfrN 6/2002
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CIRCLE ALL APPLICABLE
USE CATEGORY SINGLE FAMILY DUPLEX MULTI-FAMILY RENTAL COMMERCIAL INDUSTRIAL
SERVICE
NEW
CHANGE
TEMPORARY
NOT APPLICABLE
TYPE
OVERHEAD
UNDERGROUND
NO. OF FIXTURES
SWITCHES
NOT APPLICABLE
RECEPTACLES
CIRCUITS
AMPS
/
PHASE
VOLTS
CHECK ALL APPLICABLE
RANGE
WATER HEATER
GARBAGE DISPOSAL
DRYER
DISHWASHER_
FAN OR BLOWER_
FURNACE
A/C_
ELECTRIC SIGN____
MOTORS_
GAS PUMPS
OTHER
DESCRIPTION OF ALL WORK BEING DONE f2tpLftC0l\
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· Submit payment with appli :..ati.on. Failure to pay within 30 days will result in
fees being doubled or ~100.00 plus the normal permit fee, which ever is
greater.
VALUF CI:ncl.ud.ing labor and.
light fixtures) $ 2D 0, 00
MASTER ELBCTR~C~AN