HomeMy WebLinkAbout0022860-Electric (garage)CITY OF OSHKOSH N4 22860
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ------------
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PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING COP
Size
Foundation
Sq. Ft.
# Rooms
Class of Const.
# Stories
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
Fixtures ~_ Switches -~~ Receptacles ~_ Circuits
~"l~,._
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
FEES: Valuatio $ l Permit Fee Paid $ ` 5 Park Dedication $
ISSUED BY Date < Final/O. P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE
ADDRESS
AGENT/OWNE
W J~ ~
DATE
-~ TELEPHONE #~
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
WINNESAGO COUNTY )
`~ fie, ~~ ~1e l~ (' LJ (~
Name Address
first being duly sworn on oath, deposes and says that he is not
a 2leensed 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 av=ili~ary buildings being so
wired are not to be used or erected for rental purposes or far
resale to present or prospective purchasers.
Affiant understands that the electrical worst authorized by
the permit applied for in connection with this affidavit, must
be done only by this afflant and that he cannot employ others to
assist with the electrical work but members of his Immediate
family. l
Dated this day of C[ 6 ~ t , 19~.
Subscribed and sworn to before
this ~_ day~f
,19'x.
Notary ~exbllc, Winnebago County, Wisconsin
My Commission Expires: ~ ~`~~