HomeMy WebLinkAbout0142352-Electric i �
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City of Oshkosh
Division of Inspection Services � � �1;��� `
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P.O.Box 1130
Oshkash,WI 54903-1 1 30 `
Phone(920)236-5050
Fax (920)236-5084 �VO.IH
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ELECTRtCAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
• Application(s)and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services,PO Box 1128,
Oshkosh WI 54903-1128. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the
normal permit fee,which ever is greater.
OR
If vou are a contractor oarticipating in the Permit Fee Account System and have adequate funds check here
►f vou want this processed through your account ❑
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DATE g z Il� �
JOB ADDRESS .: � � � . I��r�� {
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�W�R 1•l��/'� / �/d� � �� s
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CONTRACTOR t-'�o w�-��, �/�c ���. �
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CHECK B(ALL APPLICABLE
USE TEGORY
ingle Family ❑Duplex �Multi-Family ❑Rental �Commercial ❑Industrial '
:
SERVICE ONew OTemporary TYPE ❑Overhead �ot Applicable ;
❑Change �N�Applicable ❑Underground �
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FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles# Circuits#
Phase t
Amps Switches# Fixtures#
CHECK �ALL APPLICABLE
�Range ODishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower �Furnace ❑A/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRI�PTION OF ALL W ORK BEING DONE U-,-� �or ir.�•.� �� c .�,,�r-}-
es�-�.�..-�n.s� �,.�
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VALUE (Iacluding labor and all materials including light fixtures)� 2 J� �
�MASTER ELECTRICIAN -------
3/02