HomeMy WebLinkAbout0033792-Electric (light)~ /,~
CITY OF OSHKOSH N°_ 33792
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
--------------------- ----------------------------------------------
ADDRESS ~ D f" ~ ~~ PLAN NO.
~0 i ~ ~
OWNER
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
ELECTRIC CONTRACTOR ./
Electric Serv. New ^ Change ^ Temp
Fixtures ~ Switches
PLUMBING CONTRACTOR
BT WH
Lav Sh
WC _ FDr
-Sink LTub
Other
Heat Loss
BTU'S
~ Type ^^ Volts Amps
Receptacles -Y~ Circuits __~
- Disp WSoft _ CBasin
DW DF -San. Sewer
SP Ur _ Storm Sewer
-Eject SS Water
FEES: Valuation $ ~~gg v ~
~/D-~- a
Permit Fee Paid $ ~~~_
Park Dedication $
ISSUED BY Date ~-~~ ~J _ Final/O.P.
In the performance of
SIGNATURE
ADDRESS
I agree to perform all work pursuant to rules governing the described construction.
A EN
r.~v ~
~-~~-97
DATE
TELEPHONE #
AFFIDAVIT BELAYING TO SECTION 13.12 {c) CP A GENE.~L CBDINA~IC^
OF TBE CITY OF OS~SOSH _~F.T•nTING TO TBE LICENSING OF EL"CT:?ICIr1NS
AND P:iOPIDI~TG PENALTIP,S
STATE OF WISCONSIN)
SS
WINNEBAGO COUNTY )
Name Address
first being duly sworn oa oath, deposes and says that he is not
a 2laensed electrician Sn the City o£ Oshkosh and that he has
applied for an'electrical permit to do electrical work in a
residence and/or au$illazq buildings (Sntended solely for pur-
poses associated with a residence) which is owned and occupied
by him, or is being coastrvcted in his name, as his personal
home and that said residence or aus311ary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospecti4e 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
_,LL__ ~
Subscri'oed and sworn to befor
this ``l ~ day~of
19=.
Notary ~ucllc , Wlnneba o County, ~+~isconsin
My Commission Expires: Z t E,