HomeMy WebLinkAbout0001131-Electric CITY OF OSHKOSH N2 01131
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELE
4
PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS
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1,)7 PLAN NO.
OWNER — /M
DESIGNER
USE /NATURE OF WORK 1..C��/
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
if /
ELECTRIC CONTRACTOR
Electric Serv. N w ❑ Change ❑ Temp !/ Type Volts Amps
Fixtures Switches I/ X Circuits
PLUMBING CONTRACTOR
- BT WH _ Disp WSoft CBasin
— Lay _ Sh DW DF San. Sewer
— WC FDr SP Ur Storm Sewer
__Sink _ LTub _ Eject SS Water
Other
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FEES: Valuation $ o Cf ` ��Permit Fee Paid $ / 7----7:6 Park Dedication Q $
ISSUED BY Date 7 - Final /O.P. ! '0 `i&
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE i /tX,/Llnli )cJ) J 1, r �� /�' 1
AGENT /OWNER
��t /
DATE
ADDRESS. 3 / I /ThAt t o /-4. .A.3?-- 5'03
TELEPHONE #
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
%STATE OF WISCONSIN) '
) SS
WINNEBAGO COUNTY )
;tl F F e loi A-(. S c f e 4 4 t. a3) , Th f /c (Jq .
(Name) (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.
Dated this e day of /0 fA l,, . , , 19,41..
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_ A .. A ./..1-42.S. 4 1 . .ICI
4 ,, /
Subscribed and sworn to befo -
this o day of O i L+ , 19 r ().
Y Vlit Ja 0 Cv
Notary lic Winnebago County, Wisconsin
My Commission Expires: -1a -Pt
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