HomeMy WebLinkAbout0144104-Electric (1) CITY OF OSHKOSH No 144104
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1300 S KOELLER ST Owner SHOPKO SPE REAL ESTATE LLC Create Date 11/09/2010
Contractor SUBURBAN ELECTRICAL ENGINEERINI Category 643 - Commercial- Addition /Remodels Plan
Service 0 New O Change O Temp • N/A Type ❑ Overhead 0 Underground
Volts Circuits 4 Luminaires 12
Amps Switches 6 Receptacles 20
Appliances
Use /Nature of Construction of 500 sq ft Quick Care clinic as per plans.
Work
Fees: Valuation $10,750.00 Plan Approval $0.00 Permit Fee Paid $219.00
Issued By: Date 11/16/2010
❑ Permit Voided Parcel Id # 1308500100
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address 709 N HICKORY FARM LN APPLETON WI 54914 - 3032 Telephone Number (920) 739 -5156
To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050
Fax (920) 236-5084
ON TH ' WA Ic
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
• Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903 -1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if you want this processed through your account ❑
DATE 00h°
JOB ADDRESS SOo S k6 r. ilcr Si
OWNER tPk0 Be 11ir E
CONTRACTOR
�SLcb1fbar) er NOV (._ 1 6 2010
DEPARTNEN'r
COMMUNITY DEVELOO PMENT
CHECK 0 ALL APPLICABLE INSPECTION SERVICES DIVISION
USE CATEGORY
❑Single Family ❑Duplex ❑Multi - Family ❑Rental €ommercial ❑Industrial
SERVICE ❑New qTemporar TYPE ❑Overhead lot Applicable
❑Change P.Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THENUMBER
Volts Receptacles # 0?0 Circuits # 1 4
Phase
Amps Switches # ;: `L ''` Fixtures # l'
CHECK 0 ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer 1Water Heater
Fan OR Blower ❑Furnace DA/C 'f lElectric Sign
❑Motors ❑Gas Pumps ❑Other / �
DESCRWTION OFy� IILL WORK BEING DONE kC / /
LOCO k in Cfin [
VALUE (Including labor and all materials including light fixtures) $ /8/ 7 5(0. b U
� � /
MASTER ELECTRICIAN 5 ��
3/02