HomeMy WebLinkAbout0019176-Electric (service change)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
19176
TYPE~ . . BLDG .0 . ~TG . 0 ~LEc)( PLBG. E? . SIGN .0 . lO.N '~~. . . . . . FL~~D PLAIN. . . . . . H EIG~T . . . _
ADDRESS ~~~~ PLAN NO.
OWNER _ ___<: - ~i
DESIGNER
USE/NATURE OF WORK
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'1_ ~.CJ~ ]>-1 L9 C:J
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BUILDING CONTRACTOR
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Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of, Const.
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System Heat'
ELE~:::~c ~~:TRAC~: 0 Ch""g~em;~
Fixtures Switches Receptacles ^'
Loss
BTU'S
~ :,jO
Volt rfO Amps~
Circuits Oc:::"
p,
PLUMBING 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
ISSUED BY
o ~ermit Fee Paid $
Date
/~f"cL-
. (.
~....~y--?O
Park Dedication $
Final/O.P. 1- 1- 10
In the performance of this work I agree to perform all work pursuant to n,Jles governing the described construction.
SIGNATUR
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QB 90
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c:Q3 3-(0 ~ ~ \
TELEPHONE #
ADDRESS
AFFIDAVIT RELATING TO SECTION 13.12 fc) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH BELATING ro TE;E LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
} SS
WINNEBAGO COUNTY )
('~~'\ti-\-\~, j ~'DQefek;
Name
2~q \\Q,\,~, so'(\ ~t.
(Address)
f1rst be1ng duly sworn on oath, deposes and says that he 1s not
a l1censed electrlc1an ln the C1ty of Oshkosh and that he has
app11ed for an electrlcal permlt to do electr1cal work 1n a
res1dence and/or aux111ary bu11d1ngs (1ntended solely for pur-
poses assoc1ated w1th a res1dence) whlch 1s owned and occup1ed
by h1m, or 1s be1ng constructed ln h1s name, as his personal
home and that sald res1dence or aux1liary bu1~d1ngs belng so
w1red are not to be used or erected (~r rental purposes or for
resale to present or prospect1ve purchasers.
Aff1ant understands that the electrlcal work authorlzed by
the perm1t app11ed for ln connectlon With this affidav1t, must
be done only by th1s aff1ant and that he cannot employ others to
ass1st w1th the electr1cal work but members of h1s 1mmed1ate
fam1ly.
Dated th1s
de
day of ~) \. ~ \'\ P
, 193.Q.
Subsc~1bed and sworn to before
~d: il~ · 19ZL.
No~a~~b11c, W1nnebag County, W1scons1n
M7 Comm1ss1on Exp1res:
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ELEC. CONTR.
,APPL. DATE ~ -:z T-?L?
/
PERMIT NO.
cArnER 13 - . ~;Jt -1+
ADDRESS c:<. ~ CJ 9' - ,~~ .-.
NATURE OF WORK '
if ELEC. SERV.
DESC. TYPE
FIX'S
APPLIANCES
CHANGE
- tc.- -tJ H-VOLTS
kECEPT S
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V' "'"
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S~RVIClt. .
PERMIT FEE /5 ~
TEMP.
AMPS a
CIRC' S~
S I"GN S
INSP. ROUGHIN l
EST. COST !} () C1 ~
REMARKS -
FINAL 1~9-YLJ
DATE PD , -:z.~.'1t) .
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