HomeMy WebLinkAbout0039522-Electric (garage)~.V l 7l
n ~ CITY OF OSHKOSH N° 39522
rERMIT - APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ~ PLBG ^ SIGN
^ ZONING FLOOD PLAIN HEIGHT
-----------------------------------
ADDRESS_T(2/ LU
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft.
Foundation
# Rooms # Stories
Class of Const.
Height
Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss
BTU'S
ELECTRIC CONTRACTOR ~-~ ~A ~ ~,~/~,,e ~~~ ~ ~~ ~
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps s-r-
Fixtures ~_ Switches ~/ Receptacles ~ Circuits
PLUMBING CONTRACTOR
- BT - WH - DisP - WSoft
- Lav - Sh - DW _ DF
- WC - FDr - SP
- Ur
- Sink - LTub -Eject - SS
Other
FEES: Valuation
ISSUED BY C
- CBasin
-San. Sewer
-Storm Sewer
- Water
~~ Q/ .. Permit Fee Paid $ ~ ~ `d '~ Park Dedication
'°"4~~[""~ Date .~~ ZO
Final/O. P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE _~!
e
PLAN NO.
/1~]CIY 11 V YYIVCI'7
ADDRESS
DATE
~d~~ /v~-
TELEPHONE ~
,r;
AFFIDAVIT RELATING TO SECTION 13.12
OF THE CITY OF OS$KOSg aELATING TO
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGC COUNTY
(c) OF A GENF"a a r. OADINANC~
THE LICENSING OF EL?CTAICIANS
(Na '
Address
first being duly sworn on oath, deposes and says that he is not
a licensed electrician in the City of Oshkosh and that he has
applied for an electrical pbrmit to do electrical words in a
residence and/or auxiliary uildings (intended solely for pur-
poses associated arith a residence) which is owned and occupied
by him,. or. is being constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used ar erected for rental purposes or for
resale to present or prospective purchasers.
Affiant~understands that the electrical words authorized by
the perait applied For In connection •~ith this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical wor$ but' mesabers of his immediate
family.
Dated this day of /~/~~/
19~.
Subscribed and sworn to before
this __ day of
19_.
iJotary ?ubllc, Winnebago County, ldisconsin
My Commission ~'xpires: