HomeMy WebLinkAbout0017976-Electric (service change)PERMIT - APPLICATION AND RECORD CITY OF OSHKOSH
OSHKOSH Address _ �✓ Owner
Lot Block Ward Subdivision
Type of Permit: Building ❑ Electrical Heating ❑ Plumbing ❑ Sign ❑ Wrecking ❑ Fence ❑ Pool ❑
Nature of Work ;f "'
PLUMBING CONTRACTOR
Bu. San. Sewer Curb to Bu.
Bu. St. Sewer Curb to Bu.
Main to Curb:
Main to Curb
Sewer Fees
Water Service
Bath Tub
Floor Drain
Urinal
Wash Basin
Garbage Disp.
S. Sink —
Water Closet
Dish Washer
Catch Basin
Kit. Sink
Laundry Mach.
S. Pump —
Water Heater
Water Soft..
B & S Waste —
Shower Bath
Bubbler
Conductors
Plumbing Fees
Total Fees
HEATING CONTRACTOR
Fuel: Gas ❑ Oil ❑ Elec. ❑ Solar ❑ Solid ❑
Conditioning Forced Air ❑ H.W. ❑ Elec. Base ❑ Steam ❑ Radiant ❑
System High Eff. ❑ Supplementary ❑ Air Cond. ❑ Ventilation ❑
Chimney: "A" ❑ "B" ❑ Direct Vent ❑ Con. Burner ❑ Flue Damper & E.I. ❑
Calculated Heat Loss Sygem BTy Rating
r
ELECTRIC CONTRACTOR
Electric Service: New Changes Temp.
Description -Type — Volts ��`r` Amps
Fixtures — Switches Recep's Circ's
Appliances
BUILDING Use
General Cont. —
Roof
Foundation
Size:
Height:
Zoning
Occupancy Permit
feet wide X feet long
Width of Lot
Stories and Basement
Height Pei
— Insp.
Siding
Type of Con
0
L
11.
Q
Square
No. of
Mason
Carper
Archite
Inspec,
Footint
Electric
Sewer.
Final_
Estimated Cosh Fees Paid
TO THE BUILDING INSPECTOR: In accordance with Section 7 -18 of the Municipal Code
discontinued for a period of 30 days at any time for any cause after excavation work is corr
five feet in height shall be erected all around such excavation. Such barrier, wall or wire fen
Building Inspector. X
In the performance of this work the undersigned agrees to abide by and
codes, and rules governing the described construct'
(Signed)
Address
By
(Authorized Signature)
Electrical Signs Address
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
ame 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 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 for rental purposes or for
resale to present or prospective purchasers.
Affiant understands 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
Subscribed and sworn t before
th s il�' da y o
Notary Public, Winnebago County, Wisconsin
My Commission Expires:_,-, - - >'�-