HomeMy WebLinkAbout0000009-Electric (service change)ELECTRICAL INSPECTION DIVISION — City of Oshkosh PERMIT
PERMIT TO DO ELECTRICAL WORK
Lot I Block Addition
CITY ELECTRICAL INSPECTOR
Ward
Date
N° 9
10 -19 -7b
Permit to install wires and apparatus as listed herewith in the premises of
....... .....Donavon...Weitz........... owner Occupied as ...............Single
........ .. .... ...........................I... ..... ..Renter .,
1303 Street.. Hazel St. ............. Floor.............. ..............I.........I. ROOM . ............................... ............................................... ............................... .................... ...............................
Contractor......... Owner ......................................................... ............................... ........................Address ................................................................................................................. ...............................
iNew '•Replace - ` i New Replace• j New Repiace• New Replace went I I ment I went 1 went
Fixtures
(
Remarks
JjFan
or Blower
X
Outdoor Sign
Date Amount .8 c.00
........................
Final Inspection .......... ...............................
Switches
(
Unit Heaters
Indoor Sign
Receptacles
Furnace or Boller
Service ,
X
2/3()
tc
3/100 Amp .
Circuits
3
20
p
Range
Air Conditioner
n ergro
n
Garbage Disposal
Water Heater
I
Electric Heating'
Dish Washer
Dryer
Motors
Horse power
of each
Transformers
Capacity
of each
Void after
Date................................... ...............................
Valuation of Work Described Herein
and I9nsgpection Fee Received
Remarks
No. of Inspections and Dates
ppPermit
400.0.0
$.... ... ............. .....................I.........
Date Amount .8 c.00
........................
Final Inspection .......... ...............................
This permit authorizes only work applied for herein. Other work must be covered by additional permits.
/ 'L - � % ... .. .. .......
Master Electrician or other Authorized Pex E ctri Inspector
AFFIDAVIT Y OFTQSHKOSH RELATING3TO THE )LICENSING OF ELEDCTRICIANS
OF THE CITY 0 0
AND PROVIDING PENALTIES
STATE OF WISCONSIN) SS
WINNEBAGO COUNTY )
Z_ Z � 5
—Lj=
Name (Address)
first being duly sworn on oath, deposes and says that he is not
a licensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and /or auxiliary buildings (intended solely for pur-
poses associated with a residence) which is owned and occupied
by him, or is being constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospecti ®e purchasers®
Afflant understands that the electrical work authorized by
the permit applied for in connection with this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his Immediate
family.
Dated this day of $ l9?�
Subscribed and sworn to before
this day of 19®
Notary Public, Winnebago County, WisoQnsin
My Commission Expires: ryA;•r "