HomeMy WebLinkAbout0001727-Electric CITY OF OSHKOSH
N2 01727
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC .;j PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS �f — PLAN NO.
OWNER �! T _ )›il-/e)-1/J-c
DESIGNER
USE /NATURE OF WORK 1e
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 ❑ Chang c Temp ❑ Type/
ypef Volt. 1 r Amps -
Fixtures Switches Receptacles Circuits
aC\
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 $ J 5 4 Permit Fee Paid $ 2 o Park Dedication $
ISSUED BY Date / ' 1 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 717-0-t4/97,44-4101-• f0 - 22 -6
,�A AGENT /OWNER DATE
ADDRESS 23,x, /+'/ lluexuAt .ST , .233 /52Z
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
WINNERAGO COUNTY )
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 " day of OCT- - , 1984
Subscribed and sworn t- befo -
thi - - • of 6r , L /.. 11 die OF.
{
<5r4 • ;
Notary Public, Winnebago County, Wisconsin
My Commission Expires: �` 2� ✓(
PERMIT NO. D ( 7- 7 , APPL. DAT /Q r -2 z - F
ELEC. CONTR. �- -i ,
OWNER 'e' ' \ / - .
ADDRESS 23 , 7 ) ,,
NA URE OF WORK „� � ` _ , ta:_
ELEC. SERV. NEW CHANGE 2S TEMP.
DESC. TYPE 3 - 'v - ( d a--d &avi VOLTS r- ,fo AMPS ^c
FIX' A SW'S RECEPT S CIRC'S OS
APPLIANCES ,9r`niG,/ V
SIGNS Ck,a490)
INSP. ROUGHIN /,...d. SERVICECK.)1 FINAL
EST. COST 3, G PERMIT FEE _Z _ — DATE PD ./O--u
REMARKS
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