HomeMy WebLinkAbout0045012-Electric (sunroom addition)~ /-z~-
CITY OF OSHKOSH N°- 45012
~~ PERMIT
APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~ ~ 3 ~ ~ ~ PLAN NO.
OWNER ~"
DESIGNER
USE/NATURE OF WORK ~.~~- /C~4-mss-- ~-O~
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ FueUSystem Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type r Volts Amps
Fixtures / Switches ~ Receptacles ~ `~' Circuits
~-w~n
PLUMBING CONTRACTOR
BT _ WH _ Disp
- Lav _ Sh _ pyy
- WC _ FDr _ Sp
- Sink . LTub _ Eject
Other
- WSoft _ CBasin
- DF _ San. Sewer
- Ur -Storm Sewer
- SS -Water
FEES: Valuation $ 00 ' D D Permit Fee Paid $ ~ ~ " O ~ Park Dedication $
ISSUED BY Date ~l ~J/ FinaUO.P.
In the performance this wor^ agree to perform all work pursuant to rules governing the described construction
SIGNATURE
AGENT/OWNER
ADDRESS
-f /~ ~i
DATE
~ ~ - ~f S ~ a wl~
TELEPHONE M
AFFIDAVIT RELATING TO SECTION 13.12(C) OF A GENERAL ORDINANCE OF THE
CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS AND
PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGO COUNTY)
~~~
(Name)
2`f3S~
(Addy ss)
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 purposes 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 aze not to be used or erected for rental
purposes or for resale to present or prospective 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 ~ "7 day of 199
Subscribed and sworn to before
this day of , 19_
Notary Public, Winnebago County, Wisconsin
My Commission Expires:
PERMIT NO [ l ~ _ 4 I Z
7 '~~ ~ Z . APPL . DATE 5 /~L ~4 'r
---- ~
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SIGNS
T11TCfl n~r:i...~~~
ELEC. SERV NEW ~~~
DESC
TYPE VOLTS ~ .