HomeMy WebLinkAbout1993-Electric~l ~.--
~ CITY OF OSHKOSH N° 33170
`' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ~ 2 ~ ~ // ~a'~~ ~ ph V~ ~ PLAN NO.
OWNER ~e~lEw .CTark
DESIGNER
USE/NATURE OF WORK~PM•-.~ t ~ ~5k~e~»~~
BUILDING CONTRACTOR
Size
# Rooms
Sq. Ft.
# Stories
Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
Disp
DW
ELECTRIC CONTRACTOR f
Electric Serv. New ^ Change ^ Temp ^ Type ^,~Vl!olts Amps
Fixtures ~ Switches ~-Receptacles ~ Circuits
~-
PLUMBING CONTRACTOR
-BT -WH
Lav - Sh
- WC _ FDr
-Sink LTub
Other
FEES: Valuation
ISSUED BY~
_ 3 ~®
~~ Permit Fee Paid $ / S "'~_ Park Dedication
GL Date ~ '" z ~ - ~ Final/O.P.
In the pertormance of this work I
SIGNATURE
AGENT/OWNER
- SP
Eject
WSoft CBasin
DF
Ur
- SS
-San. Sewer_
-Storm Sewer
Water
to perform all work pursuant to rules governing the described construction.
3~~Ig3
DATE
ADDRESS _ '~~ ~ I?7c,~ii±~h l~ ~ ~3~~ 2210
TELEPHONE #
Ar^FIDAVIT BELdTING TO SECTION 13.12 (c) CF A GENE.3.4L CADINANC~
OF THE CITY OF OSHKOSH RFT.aTING TO TIIE LICENSING OF ELECT:3ICI~.NS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGa COUNTY )
e ~~r~ ~Ta~~- ~ r7 ~ ~ r
Name Address
first being duly s~rorn on oath, deposes and says that he is not
a 2lcensed electrician in 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) ~rhich Ss 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 prospecti4e purchasers.
A1'flant understands that the electrical wor~s authori2ed by
the permit applied for in connection with this af.*idavit, must
be done only by this afflant and that he cannot employ others to
assist with the electrical work but members of his immediate
faaily.
Dated this ~~ da
Suoscribed and sworr. to befor
this , a~~ day of , 19~.
Notary . u'cllc, '~Jlnnebago County, lJisconsin
~iy Commission Expires:
L ANCES ~ _'.,rC
i .~-- DA!RMTT FEE f/
REMARKS
C. SERV. NEW `-~'"'"'~' ----
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