HomeMy WebLinkAbout0011179-Electric (basement remodel)CITY OF OSHKOSH No 11179
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ~f PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ~ ~ ~ ~ / ~~-7 PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK Li(/~ ~ ~
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
# Rooms
Class of Const
# Stories
Height .
Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
Heat Loss
BTU'S
1
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp Type Volts Amps
Fixtures _~_ Switches ~- Receptacles ~ Circuits ~ r
PLUMBING CONTRACTOR
- BT WH Disp WSoft - CBasin
Lav Sh _ DW DF -San. Sewer
- WC FDr SP Ur -Storm Sewer
-Sink LTub Eject SS Water
Other
.~ v ,~-_
FEES: Valuation $ S ®`~- Permit Fee Paid $ ~//~ Park Dedication $
ISSUED BY Date ` ( `~ _~~ Final/O. P. lz `~`s ~S"~'
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
ADDRESS
AGENT/OWNER
DATE ~
a~~~~
TELEPHONE #
AFFIDAVIT RFr.eTING TO SECTION 13.12 {c) DP A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNESAGO COUNTY )
~~ ~a 7~
first being duly sworn oa oath, deposes and says that he is not
a 3lcensed electrician 1n 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 asaoaiated otith a residence) ~rhlch is owned and occupied
by hi.m, 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 pros~ctive purchasers.
APfiant understands that the electrical work authorized by
the permit applied for in connection with-this affidavit., mast
be dose only by this aPfiant and that he cannot employ others to
assist with the electrical work bvt members of his immediate
family.
Dated this t ~ day of i./ I ~~P_~~Q~4 ~ , ly,~.
a
Subscribed and sworn to before
this .L~..~.~ d8 of ~, 19,x..
No Public, Winnebago County, Wisconsin
My Commission Expires: ~~.
APPLIANCES
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REMARKS
ELEC SERV NEW CHANGE TEMP.