HomeMy WebLinkAbout0044579-Electric (service change) 6/`Z.-- r ;-
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CITY OF OSHKOSH N ° - 579
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONIN FLOOD PLAIN HEIGHT
ADDRESS (Z ( /1-GoVA PLAN NO.
OWNER Yeti Ze
DESIGNER
USE/NATURE OF WORK
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 DL61/.4
Electric Serv. New ❑ Change Temp ❑ Type 1 Volts 31) Amps/61 Fixtures Switches Receptacles Circuits 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: Valuation $ S c� O . 0 0 Permit Fee Paid $ 249* d ✓ Park Dedication
ISSUED BY / n/y------ Date \ (7 / /9 S Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE A �..
, ,
AG ` /O /OWNER DATE
ADDRESS
TELEPHONE #
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL, ORDINANCE
OF TEE CITY OF OSHKOSH.RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
s /
/ 7�C t^ ,rid'
(Name) Address
first being duly sworn on oath, deposes and says that he 1s not
a licensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical worm 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 words but members of his immediate
family.
Dated this 2/ /9 -,s day of
, 19 .
•
(,374 .2 / 4eff---„
Subscribed and sworn to before •
this _ day of , 19_.
Notary Public, Winnebago County, Wisconsin
My Commission Expires: