HomeMy WebLinkAbout0020167-Electric (garage)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
20167
TYPE:
BLDG 0 HTG D ELEC p( PLBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
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PLAN NO.
ADDRESS
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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 D AlC 0 Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp
Fixtures ~ Switches t>(
Type _ Volts _ Amps_
Receptacles ~ Circuits ~
~
PLUMB.:NG 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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c: 0 Permit Fee Paid $
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Date
Park Dedication $
Final/C.P.
ISSUED BY
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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DATE
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TELEPHONE #
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO '1'HE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OP WISCONSIN)
} SS
WINNEBAGO COUNTY )
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Name )
,
11r- ~ &-
' (Address
f1rst be1ng duly sworn on oath, deposes and says that he 1s not
a lioensed eleotrio1an 1n the City of Oshkosh and that he has
app11ed tor an eleotrical perm1t to do electrical work in a
residenoe and/or aux1l1ary bu11d1ngs (intended solely for pur-
poses associated with a residence) wh1ch is owned and occupled
by h1m, or is being constructed in h1s name, as h1s personal
home and that said residence or aux1liary build1ngs being so
w1red are not to be used or erected for rental purposes or for
resale to present or prospective purchasers_
Aff1ant understands that the electrical work author1zed by
the permit applied for in connection w1th this affidavit, must
be done only. by this affiant and that he cannot employ others to
assist with the electr1cal work but members of h1s immediate
famil,._
Dated thl s ,;? 'I
dlLy of ~UiJ.
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SUbS~~lbed and sworn to before
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t~s ,:)'-1. dlLy of ~ . 19k.
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Notary~ub11c,Winnebago County, W1sconsin
K;r Comm1ss10n E:.I:p1re s : ~ ~ I'i'? ';>...
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PERMIT NO. :<. 6/ , 7
ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVo NEW
DESC. TYP:e
FIX'S W'S
APPLIANCES
~
SIGNS
INSP. ROUGHIN ." ,
EST. COST ';( ~(J 'L-
REMARKS
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=
DATE
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TEMP.
AMPS
CIRC'S ~
SERVICE =
PERMIT FEE~5"~
FINAL
DATE PD .g'-";1. 'f-~