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HomeMy WebLinkAbout0000460-ElectricCITY OF OSHKOSH No _00460 PERMIT.- APPLICATION AND RECORD TYPE: BLDG ^ HTG ^ ELEC~PLBG ^ SIGN ^ ZONING ---------------------------------------- ADDRESS ~ ~~ OWNER /.~(/~ FLOOD PLAIN _ _ _ _ _ -HEIGHT- _ _ - PLAN NO DESIGNER USE/NATURE OF WORK BUILDING CONTRACTOR Size Sq. Ft. # Rooms # Stories Height Foundation Class of Const. Occupancy Permit HEATING CONTRACTOR Heat ^ A/C ^ Vent ^ Fuel/System _ Heat Loss BTU'S ELECTRIC CONTRACTOR Electric Senr. New ^ Change ^ Temp Type Volts Amps Fixtures ~ Switches receptacles ~ Circuits PLUMBING CONTRACTOR BT _WH Lav _ Sh WC _ FDr -Sink LTub Other Disp - WSoft - CBasin - DW DF -San. Sewer - SP Ur _ Storm Sewer -Eject - SS _ Water FEES: Valuation ISSUED BYE Hermit Fee Paid $ ~ ~' - Park DedicatioC~n $ Date - / - ~~ _ O~_ Final/O.P. / -° ~~ t~Y~ In the pertormance of this work I agree to pertorm all work pursuant to rules governing the described construction. SIGNATUF l DATE ADDRESS TELEPHONE N AFFIDAVIT BELAYING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE OF THE CITY OF OSSKOSH RELATING TO TBE LICENSING OF ELECTRICIANS AND PR09IDING PENALTIES STATE OP' WISCONSIN) SS WINNESAGO COUNTY ) ~ 2~~ ~~ ____ ,_, --~Te ss~ first being duly sworn on oath, deposes and says that he 1s not a 2lcensed electrician in the City of Oshkosh and that he has appi~led for an electrical permit to do electrical work in a residency and/or auxiliary buildings (intended solely for pur- poses associated orith a residence) which is owned and. occupied by him, or is being a©nstrvcted 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 mental purposes or for resale to present- or pro8pective purchasers. Affiant 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 ~ ~ r~,._., 19 Subscribed and sworn to before tri s /~ ~- gay of 19~. ~~~/~!~~ ~.~1_.Q.d11.Y.il~Q ~~ ~. Vl /i~lA / (/I ... Notary Public, Winnebago County, Wisconsin My Commission Ezpires:_ cS~,iO ~~o APPLIANCES REMARKS