HomeMy WebLinkAbout0011567-Electric (service change) CITY OF OSHKOSH N2 1
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC l e PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 55?2;1--- /6lS6Y� PLAN NO.
OWNER / e 6 c ) c y
DESIGNER �y
USE /NATURE OF WORK 5Thr?,-V-(Cli i C '' , J (i - 7-60 '!
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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
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ELECTRIC CONTRACTOR - 1� . " _ r �._ _ •
Electric Serv. New ❑ Change jd Temp ❑ Type../t Volts )1,S1t)Amps 4011
Fixtures Switches Receptacles Circuits
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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
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FEES: Valuation $ a Permit Fee Paid $ Park Dedication $
ISSUED BY� Date /■ ` 9 X■F Final /O.P. /1 `/7` g
In the performance of thi w I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Mg
AGENT /OWNER 4°' DATE
ADDRESS
TELEPHONE #
PERMIT NO. / / ,��4 7 APPL. ELEC. CONTR.
CONTR.
OWNER �1�' ' 4
ADDRESS
NATURE OF WORK / l
ELEC. SERV. NEW CHANGEO‹
DESC. TYPE - 6.G -- )4 VOLTS TEMP.
FIX'S SW' S ���� `� d AMPS Ad
APPLIANCES RECEPT' S CIRC' S
SIGNS
INSP . ROUGHIN SERVICEOk / - v FINAL//- /z -Y1
EST. COST ''O ' PERMIT FEE 2 DATE PD�
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REMARKS 1 -q ��l