HomeMy WebLinkAbout0025298-Electric (move receptacles) CITY OF OSHKOSH N2 25298
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECA PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 75 5 *.e et)---e PLAN NO.
OWNER �� 1-e-1,/€2--) f °�'►iQ`�
DESIGNER
USE /NATURE OF WORK , 27 '' e /1. --7% -e----P" 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 Ty
Switches receptacles la( ----- 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
C. to f
1(
FEES: Valuation $ �— Permit Fee Paid $ Park Dedication $
,,_ `
ISSUED BY Date / / —7 j Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 1 - // - 9
t AGENT /OWNER DATE
ADDRESS 1 7y s 4"v* R-
I3s ^ 3
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
WINNESAGO COUNTY )
r-c� f 7.5 cri� -�-- ,
Name) ( dress)
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.
Af£iant understands that the electrical work authorized by
the permit applied for in connection with this affidavit, must
be done only by this af£iant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this , if day of / * , 1
_ _ _
Subscribed and sworn to before
this , // , day o I LI,. %.�! �1 , 192!..
Notary ublic, Winnebago ounty, Wisconsin
My Commission Expires: ��