Loading...
HomeMy WebLinkAbout0020274-Electric~ CITY OF ,OSHKOSH N° 20274 `' PERMIT -APPLICATION AND RECORD TYPE: BLDG ^ HTG ^ ELEC/j~J PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT ~' Ar1r1RFCC ~ ~~ ~~'~ ~ ~~ of nni ~~n OWNER ~.l n ~ ~i(~ ~ - -• - • --• DESIGNER ~~//'' ~~c USE/NATURE OF WORK ~~ /~ I/ ,.~:~~l~li~. ~ / _ I y BUILDING CONTRACTOR i Size Sq. Ft. # Ro Foundation oms # Stories Height Class of Const. Occupancy Permit HEATING CONTRACTOR Heat ^ A/C ^ Vent ^ Fuel/System /~ Heat Loss BTU'S _ ~ ELECTRIC CONTRACTOR ~~~ Electric Serv. _ New~Change ^ Temp ^ Fixtures ~~ Switches ~ F !L - f l2 ~ Typa~ Volts Amps ~cles ~ Circuits 1~~ ^ PLUMBING CONTRACTOR BT WH Lav Sh WC _ FDr -Sink LTub Disp DW SP -Eject WSoft DF Ur SS CBasin -San. Sewer_ -Storm Sewer. Other I O FEES: Valuation $ ©~ '~_Permit Fee Paid $ ~ ~ GG Park Dedication $ ISSUED BY ~ g`,S'~L~ Final/O.P. 1ZT ~~D Date , In the performance of this work I agree to perform all SIGNATURE ADDRESS ~ ` ~~ vt~L pursuant to rules governing the described construction. DA ~33~ TELEPHONE # AFFIDAVIT BELAYING TO SECTI OF THE CITY OF OSHt{OSH AELA AND PROVIDING PENALTIES STATE OF WISCONSIN) SS WINNEBAGO COUNTY ) 13.12 (c) OF A GENERAL ORDINANCE G TO T$E LICENSING OF ELECTRICIANS ~ is <<~1 '~ Address first being duly s~rora on oe a Zlcensed electrician in th applied for an electrical pe residence and/or auziliary b poses associated with a rest by him, or is being construe home and that said residence wired are not to be used or resale to present or prospec Affiant understands tha the permit applied for in co be done only by this aSflant assist with the electrical ~ family. Dated this ~ d Subscribe d sworn o befo this Notary Pu c, Winnebe~. My Comm ssion Ezpires:_ h, deposes and says that he is not City of Oshkosh and that he has mit to do electrical work in a ildings (intended solely for pur- ence) which is owned and occupied ed Sn his name, as his personal: or auxiliary buildings being so rected for rental purposes or far ive purchasers. the electrical work authori2ed;by nection with this affidavit, must and that he cannot employ others to rk but members of his immediate y of - _, 19~. e _~ 19._• ty, Wisconsin PERMIT NO.,,~ 7 ~_ `_ ~ ` ~~ ~(/ C~ REMARKS