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OSH OSH CITY OF OSHKOSH No 0058320
OS OSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 100 ROLLING GREEN CIR Owner JAMES MATHUSEK Create Date 6/4/97
Contractor HOMEOWNER Category 611 - Residential -New Single Family Wirin Plan
Service 0 New O Change O Temp Type ' •ver ea. In.ergroun.
Volts 120/240 Circuits Fixtures Neon Sign Neon #
Amps 200 Switches Receptacles Neon Transformers #
Appliances
Use /Nature of New house
Work
Fees: Valuation $1,500.00 Permit Fee Paid $50.00
Issued By: Date 6/4/97
Permit Voided
The undersigned, in applying for an Electric Permit to perform electrical work within a single family home, owned and occupied
as the principle residence by the undersigned, hereby acknowledges per City Municipal Code Section 11 -22, that other
individuals may not be employed to assist with the work described in this permit unless said individuals are licensed by the
City of Oshkosh to perform said work.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature ��
/ Date
Agent/Owner
Address Oshkosh WI 54901 - 0000 Telephone Number