HomeMy WebLinkAbout0128297-Electric
e
OSHKOSH
ON THE WATER
Job Address 500 S OAKWOOD RD
CITY OF OSHKOSH
No
128297
ELECTRIC PERMIT - APPLICATION AND RECORD
Owner MERCY MEDICAL CENTER OSH INC
Create Date 12/07/2007
Contractor EXCELLENCE ELECTRIC
Category 643 - Commercial-Addition/Remodels
Service
o New
o Change 0 Temp
. N/A
Type 0 Overhead
Plan
o Underground
Volts
Circuits
Luminaires
Amps
Switches
Receptacles
Appliances
Use/Nature of Hospital/Interior alterations as described in the approved plan (Job #9056) "check #21155
Work
Fees: Valuation $4,125.00
Issued By: 3Yn~
Plan Approval
$0.00
Permit Fee Paid
$128.00
Date 12/28/2007
o Permit Voided I
Parcelld # 0613660000
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
Agent/Owner
Address
PO BOX 78
LITTLE CHUTE WI 54140 - 78
Telephone Number (920) 687-2442
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (Le. 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.
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
" ')shkosh, WI 54903-1130
r .'hone (920) 236-5050
Fax (920) 236-5084
~
OfHKOjH
ON THE WATER
ELEOTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications wili not be processed.
. Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participatinein the Permit Fee Account System and have adequate funds. check here
if yOU want this Drocessed through yOur account D
DATE
r 2-/2- 7 JOt
JOB ADDRESS $00 $.. 6/1;:::. ~oo LJ
oWNER-Ar~' N \ T'i t-b.~c:n-\ CAt2-€'
CONTRACTOR ex(!i:~LcAlGE. ELrr':n?-t C
CHECK fa ALL APPLICABLE
/ ""JSE CATEGORY
o .JSingle Family DDuplex
DMulti-Family
DRental
~Commercial
DIndustrial
SERVICE DNew
o Change
DTemporary
DNot Applicable
TYPE DOverhead
DUnderground
DNot Applicable
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
I
Receptacles #
Circuits #
Volts .
Phase
Amps
Switc.hes #
Fixtures #
CHECK fa ALL APPLICABLE
ORange
DFan OR Blower
DMotors
DDishwasher
DFurnace
DGas Pumps
DGarbage Disposal
DAlC
. DOther
DDryer DWater Heater
DElectric Sign
D~RIPTIO OF ALL WORK BEING DONE
J-6wOL. L;. Ifrz Lbnrls 6///.
~ '/L/M f f
. 4,,/~~~
0::::::=-;n;:::'ig~$ ';Jf~
'0lJt3 *9o...,~ J;1"J!f- ~ $/cJ8CJO
3/02