HomeMy WebLinkAbout0090681-Electric (receptacles)0 CITY OF OSHKOSH No 90681
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2163 W 9TH AVE Owner THOMAS O HALLQUIST Create Date 10/19/2001
Contractor W ITZKE ELECTRIC Category 643 - Commercial - Addition /Remodels Plan
Service New C Change O Temp I Type O Overhead O Underground
Volts Circuits Fixtures
Amps Switches Receptacles 2
Appliances
I
Use /Nature of
Work
Fees: Valuation
Issued By: K
ice/ Haa z recepu cies ana remove i receptacie.
$500.00 Ian Approval $0.00
Permit Fee Paid $20.00
❑ Permit Voided'
In the performance of this work I agree to perforin all work pursuant to rules governing the described construction.
Signature Date
Date 10/19/2001
Agent/Owner
Address PO BOX 102 155 E PACKER AV OSHKOSH WI 54903 - 102 Telephone Number (920) 235 -6572
"
�.ivisicn of
Inspecti4in Servi:-es
215 Church Avenue
P.O. Box 1130
Oshkosh, WI
54903 -1130
Fax (920)
236 -5084
~
Phone (920)
236 -5046
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
DAT E J
2QZ21,10 J
JOB ADDRESS o? %6 60, 977-J -. j Fg
OWNER .6k, V,-n
CONTRACTOR WITZKE ELECTRIC INC
CHECK ALL APPLICABLE
USE CATEGORY: SINGLE FAMILY[] DUPLEX❑ MULTI - FAMILY❑ RENTAL[]
COMMERCIAL INDUSTRIAL❑
SERVICE: NEW ❑ CHANGE ❑ TEMPORARY ❑ NOT APPLICABLE ,NT
TYPE: OVERHEAD ❑ UNDERGROUND ❑ NOT APPLICABLE
NUMBER OF FIXTURES SWITCHES RECEPTACLES O� CIRCUITS
AMPS VOLTS / PHASE _
CHECK ALL APPLICABLE
RANGE ❑ WATER HEATER ❑ GARBAGE DISPOSAL ❑
DISHWASHER ❑
ELECTRIC SIGN ❑
FAN OR BLOWER ❑
MOTORS ❑
FURNACE ❑
GAS PUMPS ❑
DRYER ❑
A/C ❑
OTHER
DESCRIPTION OF ALL WORK BEING DONE a.D a 12� A)(/'n
Rai/' KJV& / 'ee C P,
VALUE (Including labor and all materials including light fixtures) $ -5'.06'00
O r�
MASTER ELECTRICIAN
Submit payment with application. Failure to pay within 30 days will result in
fees being doubled or $100.00 plus the normal permit fee, which ever is greater.
•'
Check here if you want this processed through your account ❑
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