HomeMy WebLinkAbout0011513-Electric (service change) CITY OF OSHKOSH No 1
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC kr PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 3 Q 6 - .,/ e'e' "z PLAN NO.
OWNER
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A
DESIGNER
c
USE /NATURE OF WORK _
/ —3,,' 3 -/ez=>
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 s
Electric Sere.. New ❑ Change Temp 1: Type,�� Volts t 0 Amps <
Fixtures X Switches Receptacles 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
/� c G C
FEES: Valuation $ 3 - ∎ Permit Fee Paid $ � Park Dedication $ —C r, ISSUED BY / /AI = _i Date 2 ---/ `� r/� c Final/0.p. /- 07
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE al/6 k.e,... / — d 1l
AGENT /OWNER DATE
9 ADDRESS / / z ) a' vl �} A �_
TELEPHONE #
AFFIDAVIT PET•ATING 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 )
/ Name (Ad ss)
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 P.1L -C- , 19
"re.gt,
Subscribed and sworn to before
this day/4 _.._.., 1 9.•
7219))/ tri4zu)
Notary blic Winnebago County, Wisconsin
My Commission Expires: 9
PERMIT NO . l ( 3 APPL . DATE 2 .7-- - / _ ,Fg---
IP
ELEC. CONTR.
OWNER C "P27 /Z�y.,4d,
ADDRESS - '�� `"'�
NATURE OF WORK
CHANGE X TEMP .
ELEC. SERV. NEW
DESC . TYPE a'- _ 3 O 3 tl/VOLTS 1 AMPS /(X
FIX'S S )5. FIX'S SW'S RECEPT'
APPLIANCES � SIGNS SERVICE o!'(--/a- / `2 p . - g9
INS.. ROUGHIN&,k" , PERMIT FEE 2D -� DATE PD,67-/ yf
EST. COST �'Q _ -
REMARKS
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