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HomeMy WebLinkAbout0041736-Electric (service change)(~3 (~ N°-~4i1~6 CITY OF OSHKOSH PERMIT APPLICATION AND RECORD TYPE: BLDG ^ HTG ^ ELEC ~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT -----------------~J-------------------------------------------------- ADDRESS ~ Z Z ~ ~/~ ~~~ PLAN NO. OWNER c ,i~~lvn~ DESIGNER USE/NATURE OF WORK BUILDING CONTRACTOR Size Sq. Ft. # Rooms Foundation # Stories Height . Class of Const. Occupancy Permit HEATING CONTRACTOR Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR 1~L.~u/1 Electric Serv. New ^ Change Temp ^ Type Fixtures Switches Receptacles Volts3 ~~ Amps ~ ~ - 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: Valuatio $ Zm ©~ ~ a Permit Fee Paid $ r , °~ ° Park Dedication $ ISSUED BY Date ~ ~/~T_ Final/O.P. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE DATE ADDRESS TELEPHONE ~ AFFIDAVIT F~ELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE OF T~iE CITY OF OSHKOSH BELAYING TO THE 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 2lcensed 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 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 bf his immediate family. Dated this 2-~ day of ~~~ ~` , 19~ ~~~ R_ ~ ~ Subscribed and sworn to before thi s _______ day o f , 19 • PJotary Public, Winnebago County, lJisconsin My Commission Expires: