HomeMy WebLinkAbout0042574-Electric CITY OF OSHKOSH N2 42574
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS P2 3 Ge ! .( L PLAN NO.
OWNER X` 2t % .
DESIGNER
USE /NATURE OF WORK
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 /1G4,-.2v( 3 /14-0-,..-s--
Electric Serv. New ❑ ChangeTemp ❑ Type Volts3W Amps
Fixtures twitches Receptacles - Circuits
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
FEES: Valuation — 7DD . O v Permi 3 S ^ - d /
t Fee Pa $ Park Dedication $
ISSUED BY .f.(.e(G1 Date / //, /9 Y Final /O.P.
In the performance of this work I agree o p rform all work pursuant to rules governing the described construction.
I. * c
SIGNATURE ��,, 1.• Pl 7- qcy
• •,,• R DATE
ADDRESS
TELEPHONE #
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF TEE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
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 = day of 4!)o G , 1911L.
P
Subscribed and sworn to before
this day of , 19
Public, Winnebago County, Wisconsin
My Commission Expires: