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HomeMy WebLinkAbout0029097-Electric (shed) CITY OF OSHKOSH N9 29097 PERMIT - APPLICATION AND RECORD ' TYPE: BLDG ❑ HTG ❑ ELEC' PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ADDRESS / 3 3 a `" )' t� -/' 004 PLAN NO. OWNER 6- ''),P- DESIGNER f USE /NATURE OF WORK L- -//c-1 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 k Switches �c..— T Receptacles JS Circuits © C____ A.,C 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 G FEES: Valuati.n $ .� d `�� Permit Fee Paid $ / 5- � Park Dedication ISSUED BY ,��.��!/ 4 1 7_2 Final /O.P. l ! In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE ��& r MC ( 6 - $J--. AGENT/OWNER DATE ADDRESS 3 ? Z O (1--/f., A v rS + L •^J. TELEPHONE # • AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE OF THE CITY OF OSHKOSH PELATING TO THE LICENSING OF ELECTRICIANS . AND PROVIDING PENALTIES STATE OF WISCONSIN) ) SS WINNEBAGO COUNTY ) c Ca v - --4� r 3? o G 1 eo h urs f- L. (Name) r (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. O, Dated this - / day of , 19_4 ZZ--e4f e rn c CaATEZ'i Subscribed and sworn to before this __ _ day o 2e*rt-a- , , 19.. Notary i6blic, Winnebago aunty, Wisconsin My Commission Expires: ./ 9 1 h • PERMIT NO . . APPL . DATE /l 7! ELEC. CONTR. j /J OWNER Cl�`� `I�'_ ADDRESS NATURE OF WORK -,�e • ELEC. SERV. NEW CHANGE TEMP. DESC. TYPE VOLTS AMPS F X' SW' S rte`_- R CEPT' C RC' APPLIANCES S I'GNS INSP. ROUGHIN SERVICE FINAL /® -0-1P zu. COST / SD PERMIT FEE,/ 5 DATE PD .6 1.-1L REMARKS f