HomeMy WebLinkAbout0000018-Electric (service change)CITY OF OSHKOSH No _00018
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELECPLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
-------------------- -----------------------------------------------
ADDRESS / ~~ ~T - ~~/,~GGr~ ~';~L PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
~L~
`. l Q
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR ~
Electric Serv. New~Change~Temp Type ~ Volts
`Amps La'7 '~ d
Fixtures Switches Receptacles Circuits
JC~°'~~
PLUMBING CONTRACTOR
-BT - WH
Lav _ Sh
WC _ FDr
-Sink _ LTub
Other
FEES: Valuation
O
ISSUED BY _,
i ~ ~ ~~ Park Dedicatyion $
Date ~ _ ~! ~ ~ Final/O.P. O " ~-1~.+;
SIGNATURE ~L`,~>~ ~,~~~~~ ~ ~ s" - ~6
p / AGENT/OWNER) DATE
ADDRESS-,/6 .~~ ~~,~° SP' ~3~ -...3~V~-
TELEPHONE N
- Disp WSoft - CBasin
- DW DF -San. Sewer
SP Ur _ Storm Sewer
-Eject _ SS Water
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF T$E CITY OF OS$KOSH RELATING TO TRg LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGO COUNTY )
Name Address
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 pur-
poses asaoeiated 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 yr erected for rental purposes or for
resale to present or prospective purchasers.
APfiant 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 ~ da of .~~r ~
Subscribed and sworn to before
this ~ ~ day of , 19 c~.
ll _ ~~~~~~ ~ v1 n n
Notary Public, Winnebago County, Wisconsin
My Commission Expires: ~ ~lo ~d~