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HomeMy WebLinkAbout0036097-Electric (garage)~/z /~ CITY OF OSHKOSH N°- 36097 `" PERMIT -APPLICATION AND RECORD TYPE: BLDG ^ HTG ^ ELEC~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT ADDRESS ~ ~ I~~~~G PLAN NO. OWNER _ ~ ~~ U DESIGNER USE/NATURE OF WORK ~ ~~ BUILDING CONTRACTOR Size Sq. Ft. Foundation # Rooms # Stories Height Class of Const. Occupancy Permit HEATING CONTRACTOR Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR ©/.~~~ ((/OI.F ~ CJ~LY,iC ~El' Electric Serv. New ^ Change ^~ p ^ Type Volts Amps Fixtures Switches Receptacles ~ Circuits `- PLUMBING CONTRACTOR - BT - WH - Disp ~ WSoft -Lav -Sh -DW -DF - WC - FDr - SP ~ Ur - Sink _ LTub -Eject - SS Other CBasin -San. Sewer. .-. Storm Sewer, -Water FEES: Valuation $ /~®`~ O Permit Fee Paid $ ~S~`O ~ P k D ar edication $ ISSUED BY ~ 'j`~ ~ ` Date ~7E ~ Final/O.P. In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE ADDRESS oA a ~,~ i e~trnvrvt ~ AFFIDAVIT FZET.aTING TO SECTION 13.12 OF THE CITY OF OSHKOSH RELATING TO AND PROVIDING PENALTIES STATE OF WISCONSIN) SS WINNEBAGO COUNTY ) (c) OF A GENERAL 08DINANCE THE LICENSING OF ELECTRICIANS 1.~..~.`~ ~ p ' Name Address first being duly sworn on oath, deposes and says that he is not a 2lcensed 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 prospectl4e 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 `~ ~ ~y of ~~ , 193 Subscribed and sworn to before thi(sa ~~ , day /~of , 19~I_. `//I~ ~ ,,1 / A PJotary F~b~.ic, Winnebago County, tdisconsin My Commission Expires: