HomeMy WebLinkAbout0025429-Electric (service change)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
25429
TYPE: BLDG 0 HTG 0 ELEC X PLBG 0 SIGN 0 ZONING FLOOD PLAIN HEIGHT
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OWNER
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PLAN NO.
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ADDRESS
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const.,
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New 0 Chang~Temp 0 Type~ VOltsl~ I/O Amp~ I~O
Fixtures ~ Switches f>( 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 _LTub _ Eject _SS _ Water
Other
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Permit Fee Paid $
Date
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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 C;~~k'~ ~~ ~_._-
AGENT/OWNER
ADDRESS? f 6 /11/ V't" (JIl p y1
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DATE
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TELEPHONE #
AFFIDAVIT RELATING TO SECTION IJ.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
Ir-eIJv If fA ~Yl ptf
f (Name
,
7/b /P1r l/l'Y'Ylt:'rl
(Address)
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first being duly sworn on oath, deposes and says that he is not
a licensed electrician 1n the City of Oshkosh and that he has
app11ed tor an electrical permit to do electrical work in a
residence and/or auxi11ary bui1d1ngs (intended solely for pur-
poses associated with a residence) which is owned and occupied
by h1m, or 1s being constructed in h1s name, as his personal
home and that said residence or auxiliary buildings be1ng so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Arfiant understands that the electrical work authorized by
the permit app11ed for in connection with this affidavit, must
be done only by th1s aff1ant and that he cannot employ others to
assist with the electrical work but members of his 1mmediate
family.
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Dated this " ,day of e f.
, 19 9'/ .
Subscribed and sworn
clo'rJ.-d.aY
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Mr Commission Expires:
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, 199(.
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September 14, 1991
TO WHOM IT MAY CONCERN:
REGARDING 716 MT. VERNON ST.
Mr. Kelly J. Burnett entered into an agreement with
the Cooks to purchase the 716 Mt. Vernon Street
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property, City of Oshkosh, Wi., as is.
Mr. Burnett has a copy of corrections that must
be made.
Yours truly,
~/8~
G dys B Cook
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Berns W. Cook
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'PERMIT NO.
25H~<J
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ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVo
DESC. TYPE
FIX'S
APPLIANCES
CHANGE
~k/ VOLTS
RECEPT'
TEMP.
?- &EeJ AMPS 0
x.. CIRC I S D("
SIGNS )
INSP. ROUGHIN
EST. COST tJ ~ PERMIT
REMARKS . ~- ~1n
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