HomeMy WebLinkAbout0012565-Electric (change panel)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
12565
TYPE:
BLOG 0 HTG 0 ELEC ~LBG 0 SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
OWNER
4.3~ H/(j J, aLL ~
SI P'i!-r~.",s c),vt'?c4
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK C'- ha f1(j '€ M n ,,- I
,J-~ - f-w,- ~~ /#0
/' .
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
, Occupancy Permit
Foundation
Class of Const.
HIiATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
;-IlJe hY)~
Electric Servo New 0 Change 0 Temp 0 Type_ Volts_ Amps_
Fixtures L---- Switches L---- Receptacles (. Circuits '--
tfI),
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _LTub _ Eject _SS _ Water
Other
FEES: ValuaU,," lf~ tP,tj!-;:J!;-
ISSUED BY~
Permit Fee Paid $
Date
d;<(JV d V-I
1 .- /7 - $7
v
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR.~~ ,J.jhLfL._ 5 - J '7 - y?
~ AGENT/OWNER DATE
ADDRESS
TELEPHONE #
ELEC. SERV.
DESC. TYPE
FIX'S
APPLIANCES
E
~ ~ VOLTS 17;7-cJ
RECEP'Il S
PERMIT NO.
:.ELEC. CONTR.
OWNER
ADDRESS .3 -
NATURE OF WORK
SIGNS
INSP. ROUGHIN SERVICE' FINAL) -{ -?1
EST. COST PERMIT FEE tJ ____ DATE PD. -I -g'1
REMARKS If .5"I'!J.:::'>--