HomeMy WebLinkAbout0092129-Electric (a/c)/~'~ CITY OF OSHKOSH No 92129
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 665 GOLDEN IRIS DR Owner RICHARD UMARY J PALMQUIST Create Date 08/10/2001
Contractor SECKAR ELECTRIC Category 612 -Residential-Single Family Addition/R Plan
Service New ~ Change ~ Temp Type (~ Overhead 0 Underground J
Volts Circuits Fixtures
GPs Switches Receptacles
Appliances
Use/Nature of
Work
new A/C
Fees: Valuation $150.00 Plan Approval $0.00 Permit Fee Paid $20.00
Issued By: ~ Date 01/08/2002
Permit Voided
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address 5920 COURTNEY PLUMMER ROAD WINNECONNE WI 54986 - 0
Telephone Number (920) 582-4909 M 379-68~
v
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Division of Inspection Services
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903-3130
Fax {920) 236-5084
oN ~ ~ ° PhOY~e 1920) 236-5046
ELECTRICAL PERMIT APPLICATION
Ali information after bold categories. must be provided.
Incomplete applications will not be processed.
DATE Jn Iy ~~ Z,,D~ Z
JOB ADDRESS (Q 10 ~ l~Ol-~ ~~ I ~ l S
OWNER ~~ L/y1(~ U ~ S ~
corrrrtACTOR S~~C~cft-le ~~LE~71e ! C
CIRCLE ALL APPLICABLE
USE CATEGOR SINGLE FAMILY DUPLEX MULTI-FAMILY RENTAL COMMERCIAL INDUSTRIAL
SERVICE NEW CHANGE TEMPORARY NOT APPLICABLE
TYPE OVERHEAD UNDERGROUND NOT APPLICAL~LE
NO. OF FIXTURES SWITCHES
AMPS
VOLTS /
CHECK ALL AFPLICABLE
RANGE WATER HEATER
DISHWASHER FAN OR BLOWER
ELECTRIC SIGN MOTORS
FURNACE
GAS PUMPS
A/C~
OTHER
DBSCRIFTION OF ALL WORK BEING DONE lyE~(~l~ /~ ~ '(~
• Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is
greater.
VALVE (Including 1 z and all materials including light fixtures) $ ~~•O°
Y
MASTER ELECTRICIAN ,L•~ V~G
RECEPTACLES
CIRCUITS
PHASFs
DRYER
GARBAGE DISPOSAL