HomeMy WebLinkAbout0003151-Electric (service change)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
03151
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'if: 6' ~ LU;h" ~ f PLAN NO.
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ADDRESS
OWNER
DESIGNER
c.
USE/NATURE OF WORK
V'.
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const..
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
ELE9TRIC CONTRACTOR
Electric Servo New D Change D Temp Type .A 'I. VOlts~~Amps 1&0
Fixtures (/'---. Switches ~'RecePtacle. ~..Circuits ~
Heat Loss
BTU'S
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
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Permit Fee Paid $
Date
/2d
3 --/3 --517
f.. "
Park Dedication $
Final/O.P.
ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~~fi,~ ~ ') J'/=:,,:~?
ADDRESS / f /4 /{_)/~62-K ~ ffi~
d"JJ- 75?.:5~
TELEPHONE #
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AFFIDAVIT RELAtING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF TEE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF W!SCONSIN)
} 55
WINNEBAGO COUNTY
.. /Y/d>l'~ k
Address)
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f1rst being duly sworn on oath, deposes and says t~t he 1snot
a licensed electrician 1n the C1ty of .Oshkosh and t~t he has
applied for an electrical permit to do electr1cal work in a
residence and/or au:ciliary''bu1ldings (1ntended solely for pur-
poses associated with a residence)wh1ch is owned and occupied
'by him, or is 'being constructed in his naDJe, as his personal
home and that said residence or auxiliary buildings 'being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers_
Af~iant understands that the electrical work authorized 'by
the perm1t applied for in connection with this at"fidavit, must
be done only 'by this arfiant and tr4t he cannot employ others to
assist with the electrical work but members of his 1mmediate
family.
Dated this /~
day o~
SubCser1bed and sworn to before
"this .vj~3~:.. day of 7/(a.w.lt , 19l1-
- _ c:1" Qo~O- ---p ri\cJu~
N9tary Fublic, Winnebago County, Wisconsin
My Commission Expires: g!s/crt)
t.
ELEC. SEI<V.
DESC. TYPE
F!X'S
APPLIANCES
DATE .3 ---I
, PERM!T NO. @
ELEC. CONTR.
.~;.:
OWNER
ADDRESS
NATURE OF. WORK
SIGNS
!NSP. ROUGH!N
EXT. COST
REMARKS
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