HomeMy WebLinkAbout0040468-Electric (service change) &
CITY OF OSHKOSH
N2 40468
PERMIT -- APPLICATION AND RECORD
TYPc: BLDG ❑ HTG ❑ ELEC
8 PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / ‘ r 7 / J� ` PLAN NO.
OWNER / .L..._ �- �/ �.�.,
/
DESIGNER
USE /NATURE OF WORK
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 IOWA- ; u i � ���i f i
Electric Serv. New ❑ Change Temp ❑ Type0 Volts3 I%) Amps 7 v
Fixtures Switches Receptacles Circuits
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
:V I i /0���a dJ Park Dedication $
J
FEES: a uat on $ Permit Fee Paid $
ISSUED BY / ��r.Glii. -L-a Date 7 /R / �(� ,
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE iija,,. * ti 0 / ` SVC 2/i3/9y
AGENT/OWNER T SATE
ADDRESS
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 )
p hs,1 9 1/ L 14/2 / e- 5alc
(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 13 day of X4/7 , 1922..
Subscribed and sworn to before
this day of , 19 .
Notary Public, Winnebago County, Wisconsin
My Commission Expires:
•
:149 2:fS Z.3 ( 035
PERMIT NO. 1 7 4 o c( b . APPL . DATE 0 7/73/
ELEC. CONTR. 0/A1
pkee OWNE R 23/ — 5( a
� e.
ADDRESS /6 V 7 /i7 c d�ec 1
NATURE OF WORK
=C. SERV. NEW BHP E2 CP TEMP.
DESC. TYPE of VOLTS � w AMPS /m
FIX'S SW' RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP . ROUGHIN SERVICE 7/194 'f FINAL //We
-
EST. COST PERMIT FEE DATE PD.
600 4.-..e af 0-1 Gd>n.r ()zT.L` ee.f�. 3 0 . 0,4144 w P'S
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