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OSHKOSH
ON THE WATER
Job Address 1250 HARNEY AVE
CITY OF OSHKOSH
ELECTRIC PERMIT - APPLICATION AND RECORD
No 93412
Owner
ANGELA R GAJEWSKI
Create Date 04/03/2002
Contractor
SOLAR ELECTRIC SERVICES INC
Category 612 - Residential-Single Family Addition/R Plan
Service
p New
o Change
o Temp
Circuits
Type 0 Overhead
o
o
o Underground
Volts 220
Fixtures
o
Amps 0
Switches
Receptacles
o
Appliances AlC
Use/Nature of SFRI Wiring for new AlC.
Work
Fees: Valuation
Issued By: k VV\
$200.00
Plan Approval
$0.00
Permit Fee Paid
$20.00
Date 04/03/2002
o Permit Voided I
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Address
3443 BROOKS ROAD
Agent/Owner
OSHKOSH
WI 54904 - 0
Telephone Number 231-3990 fax236-7725
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OfH<OJH
ON THE WATER
Division of Inspection Services
21.5 Church Avenue
P.O. Box 1.1.30
Oshkosh, WI 54903-1130
Fax (920) 236-5084
Phone (920) 236-5046
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
JOB ADDRES S .I f~ S ~ cJ-/4 ~ l-t <.#'1'
OWNER -4 fL e$ ,,;[C, f:aJ Pi(. -1: /
CONTRACTOR ~~. kvl/- j;te if
DATE 1/3/rJ L
(' tr~s fey J
CIRCLE ALL APPLICABLE
USE CATEGO~LE
SERVICE H
F~UPLEX
CHANGE
MULTI-FAMILY RENTAL
COMMERCIAL INDUSTRIAL
TEMPORARY
NOT APPLICABLE
TYPE
OVERHEAD
UNDERGROUND
NOT APPLICABLE
NO. OF FIXTURES
SWITCHES
RECEPTACLES
CIRCUITS
AMPS
VOLTS Z- W /
PHASE
CHECK ALL APPLICABLE
RANGE
WATER HEATER
GARBAGE DISPOSAL
DISHWASHER
FAN OR BLOWER
FURNACE
DRYER
A/C-X
ELECTRIC SIGN
MOTORS
GAS PUMPS
OTHER
DESCRIPTION OF ALL WORK BEING DONE
Uh""fA '-{' 1;1. <(). t't.-V a 1 '{;.. Con d ['fr d)'"U+t..
. Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.
VALUE (Including
all materials including light fixtures) $
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MASTER ELECTRICI
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