HomeMy WebLinkAbout0044217-Electric (service change)
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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44217
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7// ~d./
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ADDRESS
PLAN NO.
OWNER
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR a(~/I..
Electric Servo New 0 Change)!( Temp 0 Type ~'VOlts :J tJ Amps /8-V
Fixtures Switches Receptacles Circuits
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
- ,/
FEES: Valua.o~ t" 0 ~ . Penn. Fee Paid $ 7-8. .0 <J
ISSUED BY ~ ~ Date '3/z..) /7' j
~ . /
"
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
eO~\~UA^
~W'R~
c/d~ Jt7';r)
3- d. 1./--9s-
DATE
ADDRESS
TELEPHONE #
f
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AFFIDAVIT RELATING TO SECTION 1J_~2 (c) OP A GEN&~ ORDINANCE
OF THE CITY OF OSHKOSH BELAl'ING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) S5
WINNEBAGO COUNTY )
f)~~~
,
911 ~d
(Address)
f1rst ce1ng 4uly sworn on oath, deposes and says that he 1s not
a l1censed electric1an 1n the C1ty of Oshkosh and that he has
appl-1ed for an elect:t"1cal perm1 t to do electr1cal work 1n a
res1dence and/or aux1l1ary bu1ld1ngs (intended solely for pur-
poses assoc1ated w1th a res1dence) which 1s owned and occupied
by him,- or 1s being constructed 1n his name, as his personal
home and that said res1dence or aux1liary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prespect1ve purchasers. .
Affiant"understands that the electrical work author1zed by
the permit appl1ed for 1n connect1on w1th this a~f1davltt must
be done only by this aff1ant and that he cannot employ others to
ass1st w1th the electrical work but- members o~ h1s 1mmediate
family_
Dated this
2"'3
day of
mCi/(~
, 19'Z~
-
a.~J~"Q~
Subscribed and sworn to before
this
day of
, 19_-
Notary Public, W1nnebago County, W1sconsin
My Comm1ssion Expires: