HomeMy WebLinkAbout0000058-Electric (remodel & heat)
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
00058
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OWNER
101 9' ~ jf:~
A c:rI~U< .~~.
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
~J7--~
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Foundation
Class of Const.
Occupancy Permit
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELE~:~C~~:TRAC~:R 0 Change 0 TempO -!:~VOIIs_ Amps_
Fbou,"s IX- Switches ~,fn';t~ P~,
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
Permit Fee Paid $
Date
/
J5~V/
6- fl-Y~
,
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 RMa,Ra-t~
AGENT/OWNER
Jut'\€ 4 (C[ ~ (,P
O}l.TE
ADDRESS
to L 1
11-~ -J1 .
6~
235 -()2-q r
TELEPHONE #
. .
AFFIDAVIT RELATING TO SECTION 13.12 (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 )
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_t<6b&A- ROhbt\"
( Nat:1e )
,
tOlG ~\l)t}, St OShk(\S~
Addr ss) .
first being duly sworn on oath, deposes and says that he is not
a licensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or auxiliary buildings (intended solely for pur-
poses associated with a residence).. which is owned and occupied
by him, or is being constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired a.re not t.obe used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
the permit applied for in connection with this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family_
Dated this
~. cr day of
3Lt~
, 19~-
~M{I, recJ;~
, 19it:,.
Notary
My Commission Expires:
y! \; 2/6--? 7
(
r
__y--?ft
ELEC. CONTR.
ADDRESS
~TURE . OF WORK
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CIRC'
OWNER
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