HomeMy WebLinkAbout0127941-Electric
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OSHKOSH
ON THE WATER
Job Address 855 N WESTHAVEN DR
CITY OF OSHKOSH
No
127941
ELECTRIC PERMIT - APPLICATION AND RECORD
AURORA MEDICAL CENTER OF OSHKOSf Create Date 11/21/2007
Owner
STAFF ELECTRIC CO INC
Category 643 - Commercial-Addition/Remodels
Plan
Contractor
Service
p New
o Change 0 Temp
. N/A
Type 0 Overhead
o Underground
Volts
Circuits
Luminaires
Receptacles
Amps
Switches
Appliances
Use/Nature of 'COMM / PROVIDE WIRING FOR TEMPORARY MED SURGE MOCK UP ROOMS "check #66117 & #66131
Work
Fees: Valuation $15,000.00
(;m~
Plan Approval
$0.00
Permit Fee Paid
$243.00
Issued By:
Date 11/27/2007
D Permit Voided I
Parcelld # 1621520000
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
AgenUOwner
Address
PO BOX 917
BUTLER
WI 53007 - 917
Telephone Number (262) 781-8230
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
JOb # 914650 ProjMgr: D. Hill Jeff.R.
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OJH<OJH
ON THE WATER
Division of Inspection Services
215 Church Avenue
P.O. Box 1130
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.
DATE
11-20-07
JOB ADDRESS
855 N. Westhaven
O~R Aurora Health Care
CONTRACTOR Staff Electric Co Inc
CIRCLE ALL APPLICABLE
USE CATEGORY SINGLE FAMILY DUPLEX MULTI-FAMILY RENTAL COMMERCIAL INDUSTRIAL
SERVICE
NEW
CHANGE
TEMPORARY
NOT APPLICABLE
TYPE
OVERHEAD
UNDERGROUND
NOT APPLICABLE
SWITCHES
VOLTS
RECEPTACLES
CIRCUITS
NO. OF FIXTURES
I
PHASE
AMPS
CHECK ALL APPLICABLE
RANGE
WATER HEATER
GARBAGE DISPOSAL
DRYER
DISHWASHER
FAN OR BLOWER
FURNACE
A/C_
ELECTRIC SIGN
MOTORS
GAS PUMPS
OTHER
DESCRIPTION OF ALL WORK BEING DONE
mock up rooms
Provide wiring for temporary Med Surge
. 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 labor and all materials including light fixtures)' $ 15,000.00
MASTER: ELECTRICIAN ..
~.I?I<~rJ;/)
,r'",":":' ", " .
PERMIT FEE- $195.00