HomeMy WebLinkAbout0005553-Electric (addition) CITY OF OSHKOSH N°_ 05553
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELECJ PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 11 3 ti/ PLAN NO.
OWNER IX 0 ��j�G/
DESIGNER
USE /NATURE OF WORK 1.4.-,A a4 6
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 Type Volts Amps
Fixtures —4. Switches i Receptacles Circuits f AI
g el t 2 g7 1 ,iliir
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
s c
FEES: Valuat .2-61 d Permit Fee Paid /0....._.---."-
Park Dedication
ISSUED BY Date 7`/ lJ q 7 Final /O.P. zi l q
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 9-? 7
AGENT /OWNER DATE
ADDRESS 9 4 w, nd 0 r o31-. 4/oZ 6 °0 3 7
TELEPHONE
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
.`usa /Cno6 /0c41 9 3 Gvinisor
(Name) (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 01/4k
day of 19
Subscribed and sworn to before
this c day of
M PD
Notary Public, Winnebago County, Wisconsin
My Commission Expires: g /,51 /q