HomeMy WebLinkAbout0013621-Electric (service change) CITY OF OSHKOSH No 13621
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC'PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 2 3 ` i' /-�.o PLAN NO.
OWNER
AC,,,,
C.3_.‘ .,d .
DESIGNER
USE /NATURE OF WORK /
0 g ,
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 ❑ Change Temp ❑ Typ VoltsA Volts AmpsL /�7
Fixtures Switches Receptacl — Circuits /A fk 1110
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 $ / O ` —
C Permit Fee Paid $ _. Park Dedication $
ISSUED BY # <# i. rss� / `
Date `>' 7 ----Y p 9 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE V
E NT//O ENT ���
DATE
ADDRESS
TELEPHONE #
•
P ' st_ T NO . ` 6 67 . APP . DATE
•
ELEC. CONTR.
OWNER
ADDRESS / 2. 3 -
NATURE OF WORK
ELEC. SERV. NEW CHANGE L' TEMP.
DESC. I "� - 3 U 1 ?-*z— VOLTS 1 z -2- '/o AMPS /
FIX'S C SW' S RECEPT' CIRC' S Or'
APPLIANCES
S IGNS
INSP. ROUGHIN ® c SERVIcr. tr q FINAL
EST. COST ' VC PERMIT FEE 3 5 / DATE PD .d -/ 7
REMARKS