HomeMy WebLinkAbout0039749-Electric (move meter)~3~
~ CITY OF OSHKOSH N°- .39749
~~
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS V
OWNER ~
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
# Rooms
# Stories Height .
Class of Const. Occupancy Permit
PLAN NO
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR Jl~~h'r~~ ,~
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles .
Volts Amps r ~ ~
- 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 $ ~00 • y Permit Fee Paid $ Z4• ~ Park Dedication $
ISSUED BY Date Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUF
ADDRESS
~~ ~91
DATE
TELEPHONE #
AFFIDAVIT BELAYING TO SECTION 13.12
OF THE CITY OF OSHKOSE BELAYING TO
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGO COUNTY )
(c) OP A GEN~a r. ORDINANCE
THE LICENSING OF EI.rCTAICIANS
E% Z ~C cf~~S /03 ~
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 Por 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 Por rental purposes or for
resale to present or prospective purchasers.
Af£iant understands that the electrical words authorized by
the permit applied Por in connection with this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical words but' members of his immediate
family.
Dated this ~ day of ~~~-
-~
_._~ 19~.
Subscribed and sworn to befor+
this day of , 19_•
~Jotary ?ubllc, Winnebago County, tJisconsin
My Commission Expires: