HomeMy WebLinkAbout0040997-Electric (pool)~/Z
CITY OF OSHKOSH N~ 40997
PERMIT ~ APPLICATION AND RECORD
. fPE: BLDG ^ HTG ^ ELEC~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~~ PLAN NO.
OWNER ~C~~~~.C./ N /~
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
size
Foundation
Sq. Ft
# Rooms
# Stories Height .
Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR ~(~~C.{ G~.t/t-C.
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
_BT _WH
Lav _ Sh
- WC _ FDr
-Sink _ LTub
Other
Disp - WSoft _ CBasin
- DW _ DF -San. Sewer
- SP - Ur -Storm Sewer
-Eject _ SS -Water
FEES: Valuation $ Z Ste' ~ ~ ,Permit Fee Paid $ lSr~~ 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.
SIGNATURE
DATE
ADDRESS
TELEPHONE N
AFFIDAVIT BELAYING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RFr.aTING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGO COUNTY )
/L~.~2GQ, ~ ~ 30 Gv C.~~c.Q
Name Address
first being duly sworn on oath, deposes and -says that he is not
a 3lcensed 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 yr 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 ~ day of 19~.
~-.- ~~,.
Subscribed and sworn to before
this _ day of , 19_•
Notary Public, Winnebago County, Wisconsin
Mp Commission Facpires: