HomeMy WebLinkAboutElectric CITY OF OSHKOSH No 11161
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ■,/ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /,// i em /L PLAN NO.
OWNER el4 t .NS /n' 4*Yi' E
DESIGNER /10 USE /NATURE OF WORK /Jfi.(e
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 ''" t
dti N'` 1 t CreKok 44/941(17.
Electric Serv. New Change ❑ Temp ❑ Type uG. Volts /11AV° Amps .2-
Fixtures —__X____ Switches Receptacles ) Circuits Al0 i
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: Valuati. n$ / - ` Permit Fee Paid $ > , / a Park Dedication $
ISSUED BY / /L /T / .�; � /
Date / / > 77 Final /O.P. d – 8'9
i
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE i'l i dam/ �` / ///
AGENT /OWNER ATE
ADDRESS
TELEPHONE #
PERMIT NO. / //(9 / , APPL. DATE / ` 7 ' 1 7� LF
ELEC. CONTR.
C� : e
OWNER
� i.e/ 4- /
_ ADDRESS �/ �- 6 -' 2 '-''
NATURE OF WOR
274 J f
ELEC. SERV. NEW D- CHANGE TEMP.
DESC. T PE ) - Li_ - ,i-4 VOLTS / ve AMPS 2O"
FIX'S ( SW'S RECEPT' CIRC'S
APPLIANCES 4p
IISNS a✓V FINAL a -i /7
EST. COST
INS.. ROUGHIN -- 5 RMI T I FEE 75";: DATE PD. //. �'- 1
Sdd '
REMARKS