HomeMy WebLinkAbout0009283-Electric 40) CITY OF OSHKOSH No 09283
- PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC J PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS W.,72. Uti /netnit 0` PLAN NO.
OWNER .-- Y - 71--e--Z /9ciyizi_etee
DESIGNER
USE /NATURE OF WORK WA--/.1. �0 - ' -C /,. : + ∎
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 9
Electric Serv. ( New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures �\ , Switches Receptacles " \ Circuits """ a
411P /
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 $ L 0 Permit Fee Paid $ - Park Dedication $
ISSUED BY Date 7 `7 1-.8g Final /O.P. / , ^F7
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Cto-- -M
ADDRESS 7 / 9/1/ 375 - ? 5 1 f
TELEPHONE #
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AFFIDAVIT BERATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO TEE LICENSING OF_ ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
1 ' e J l(0 rte' a ,
(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.
i
Dated this 1 day of d u , 19
C-'97t.ta<_ri 411P /
Subscribed and sworn to before '
this day of , / , , 19.
/7 ...ge 474 44 1 1 "
Notar Public, Winnebago County, Wisconsin
My Commission Expires: 4•
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