HomeMy WebLinkAbout0015594-Electric (addition)~ CITY OF OSHKOSH N° .15594
`' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC~ PLBG ^ SIGN ^ ZONING _ - FLOOD PLAIN _ _ HEIGHT- _ _
ADDRE:
OWNER
DESIGNER
C.
C
USE/NATURE OF WORK ~/~~ ~
BUILDING COQ
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 eceptacles Circuits
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: Valua ' n $ ~ ~ ~ it Fee Paid $ !~'S" ~ Park Dedication $
ISSUED BY Date F ~G ~~~ Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
ADDRESS
~~
DATE
~~~~~~
TELEPHONE #
AFFIDAVIT BELAYING TO SECTION 13.12 (c) OP A GENERAL 08DINANCE
OF THE CITY OF OSHKOSH RELATING TO T$E LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNE8AG0 COUNTY ~
s
Name Ad ss
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
appl•led for an electrical permit to do electrical work in a
residence and/or auxiliary buildings (intended solely for pur-
poses asaoaiated Kith 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 prospective purchasers.
Attiant understands. that the electrical work authorized by
the permit applied for in connection with this affidavit, must
be done only by this attiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this ~~ day of G~:~~, 19~
Subscribed and sworn to before
this o_(o~~ da~- of , 19,~.
Notary Public, Winnebago County, Wisconsin
My Commission Expires: /9~~--