HomeMy WebLinkAbout0025414-Electric_CITY OF OSHKOSH N°_ 25414
PERMIT APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
--------------------------------------------------------------------
ADDRESS ~ ~ ~ ~ ~ PLAN NO.
OWNER OL~X ~~ ~_~~~
DESIGNER
c
USE/NATURE OF WORK ~yi~.~ 9,~ p
BUILDING CONTRACTOR
Size
Foundation
# Rooms # Stories
Class of Const.
Height .
Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR ~
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps ~C
Fixtures ~- Switches x-~ Receptacles ~ Circuits / ~'
~-
PLUMBING CONTRACTOR
-BT WH
Lav _ Sh
- WC FDr
Sink _ LTub
Other
Disp
DW
SP
Eject
WSoft
DF
Ur
SS
- CBasin
-San. Sewer_
-Storm Sewer
-Water
FEES: Valuation $ ~_Permit Fee Paid $ q~.~~'"~i-~ Park Dedication $
ISSUED BY Date L.~~ ! `~` Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 1 !~ l
r-~ AGENT/OWNER DATE
ADDRESS ~~~~ `~ ~ ~Q~ll~ ~ ~-~~. ~~ - ~ f
TELEPHONE #
Sq. Ft
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENFAat" ORDINANCE
OF THE CITY OF OSBKOSH BELAYING TO THE LICENSING OF ELECTRICIANS
AND P809IDING PENALTIES
STATE OF WISCONSIN)
SS
WINNESAGO COUNTY )
Name Address
first being duly sworn on oath, deposes and says that he is not
a lieeased 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 prospective purchasers.
Affiant understands that the electrical work authorized by
the permit applied for 3n 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 L~=_ day of ~• , 19 ~~.
Subscribed
thi 4 ! ~~
_m___~
and sworn to before
day
19L•
Notary f~ublic, Winneb County, Wisconsin
My Commission Expires: `~9.2