HomeMy WebLinkAbout0091691-Electric (ground rods) C la CITY OF OSHKOSH No91691
OSHKOSH ELECTRIC PERMIT APPLICATION AND RECORD
ON THE WATER
Job Address 2003 WINCHESTER AVE Owner DAVID R ROTHE Create Date 12/06/2001
Contractor LARK ELECTRIC Category 612 Residential Single Family Addition /R Plan
Service b New 0 Change 0 Temp Type Overhead 0 Underground
Volts 120/240 Circuits Fixtures
Amps 100 Switches
Receptacles
Appliances
Use /Nature of SFR/ Install ground rods link to system.
Work
Fees: Valuation $400.00 Plan Approval $0.00 Permit Fee Paid $20.00
Issued By: ryl Date 12/06/2001
Permit Voided
In the performance of this work I agree to perform all work pursuant to rules goveming the described construction.
Signature Date
Agent/Owner
Address 927 N LARK ST PO BOX 3206 OSHKOSH WI 54902 3347 Telephone Number (920) 231 -8625
0 Division of Inspection Services
215 Church Avenue
P.O. Box 1130
a= 1 1 Oshkosh, WI 54903 -1130
Fax (920) 236 -5084
ON THE WATER
Phone (920) 236 -5046
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
DATE y 224 o
JOB ADDRESS a00 3 cJ /.mac e TE/2
OWNER D/9 U/ 0 Tv/E
CONTRACTOR 14 ,2. e
CIRCLE ALL APPLICABLE
USE CATEGORY SINGLE FAMILY DUPLEX MULTI- FAMILY RENTAL COMMERCIAL� INDUSTRIAL
SERVICE NEW CHANGE TEMPORARY -NOT 122
TYPE ERHEAD UNDERGROUND NOT APPLICABLE
NO. OF FIXTURES SWITCHES RECEPTACLES CIRCUITS
AMPS /06 VOLTS ZO 2 4 PHASE
CHECK ALL APPLICABLE
RANGE WATER HEATER GARBAGE DISPOSAL DRYER
DISHWASHER FAN OR BLOWER FURNACE A/C
ELECTRIC SIGN MOTORS GAS PUMPS OTHER
DESCRIPTION OF ALL WORK BEING DONE i 7"4IL FD 66.61614.40 /4.40 t1 DS e L
Ti s /4/.
T 5
1
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.
VALUE (Including labor and all materials including light fixtures) Y490/
MASTER ELECTRICIAN j L 4ep�ir___,-