HomeMy WebLinkAbout0020241-Electric (service change) CITY OF OSHKOSH N°_ 20241
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC IPLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS , S *GYM 4, 'p PLAN NO.
OWNER /03( r Mil -1417 0
DESIGNER /�
USE /NATURE OF WORK ° /Co ,Si a irK Z /CO # , Id/ '
OVP, ea
/ ,
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 , 3b / G7-/ C'
Electric Serv. New ❑ Change lifr Temp ❑ Type 4 Volta 4 mp—'
Gi '
Fixtures Switches Receptacles Circuits � lir
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
d ∎ 0
FEES: Valuation $$ � Permit Fee Paid $ 2 Park Dedication $ q/
ISSUED BY ��� e�1,�C�i -1 Date 3/ " PZ Final /O.P. o 12 7
In the performance of this work I agree to :-rform all work pursuant to rules governing the described construction.
SIGNATURE /
IGNATURE '� /�� ■ ..0",,, l' F-31 --","
AGENT /OW ER DATE
ADDRESS
TELEPHONE #
PERMIT NO. •APPL. DATE
ELEC. CONTR. _e,.. -
OWNER
ADDRESS 3
NATURE OF OF WORK
ELEC. SERV. NEW CHANG TEMP.
DESC. TYPE 3 at 3 - VOLTS CZ 1.-4 AMPSZ el
FIX'S SW'S RECEPT'S CIRC'S I'
APPLIANCES
SIGNS C-Letg
INSP. ROUGHIN SERVICE/N-5 0 FINAL`( 7 - 9'
EST. COST ��a PERMIT FEE .1Gl DATE PD.'3 /P25'
REMARKS