HomeMy WebLinkAbout0010261-Electric (service change)~ CITY OF OSHKOSH No 10261
~' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ~PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~ ~ ~ " ~ ~ ~~~K--~ PLAN NO.
A / ~ ~/~
OWNER
DES
c
USE/NATURE OF WORK
3 '"/O O
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. 'Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR /.~-
Electric Serv. New ^ Change ~ Temp ^
Fixtures ~_ Switches ~ F
PLUMBING CONTRACTOR
- BT _ WH Disp
- Lav - Sh _ DW
- WC _ FDr _ SP
- Sink LTub -Eject
Other _ _
-~
Type ,'~j Volts / ~~ mps ~O
icles Y ~- Circuits ~
WSoft
DF
Ur
SS
- CBasin
-San. Sewer_
-Storm Sewer
-Water
FEES: Valuation $ Q ~ Permit Fee Paid $ ~ _ Park Dedication $
ISSUED BY Date ~~ _ ~~ Finat/O.P. ~' ~''
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUF
ADDRESS
DATE
~~J PH~~~
AFFIDAVIT BELATiNG TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH BELAYING TO THE LICENSING OF ELECTaICIANS
4ND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNESAGO COUNTY )
Name ~ Address
first being duly sworn on oath, deposes and says that he is not
a 2lceneed electrician 1b the City of Oshkosh and that he has
applied 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 erectad for rental purposes or for
resale to present or prospeati4e purchasers.
Affiant uaderstands 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 of his immediate
family.
Dated this ~~ day of _ ~`, 19¢.x.•
Subscribed and sworn to befo
this ~ day of ~._, 19~.
Notary blic, Winnebago County, Wisconsin
My Commission Expires: '~' 99~-