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Home My WebLink About0032863-Electric CITY OF OSHKOSH N°_ 32863 PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC X PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT / k / ■ ADDRESS _ _ / - PLAN NO. OWNER f et� CZ 0-� —�—� �� DESIGNER � USE /NATURE OF WORK ,�Ci(/�t�.�o t4-..,...-4 ' Y 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 r Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps PC---Switches ( Fixtures — Switches ' Receptacles P Circuits 4 3 r 6 - 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 G I FEES: Valuation $ -6 C- permit Fee Paid $ ` J pp Park Dedication $ ISSUED BY Date 3 3 `" ` li Final /O.P. iLP -93 In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE / ( u_ l� ` a J !fc w `j 3 AGENT /OWNER DATE ADDRESS Z Ql7 5 e f! l (,J 1- 51 / 9 N Y.Q6 a3..? TELEPHONE # AFFIDAVIT RELATING TO SECTION 13.12 (c) CF A GENERAL ORDINANCE OF TEE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS AND PROVIDING PENALTIES STATE OF WISCONSIN) ) SS WINNEBAGO COUNTY ) Ro si e %C IVotlhexs aYoz 61)e idafc - ahh i, ze?z (Name) (Address) SW 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 1s 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 3 day of / l(a' /_V'1 , 19x. 1 Subscribed and sworn to before this 3 day of 4 19,22L. Notar., Public, Winnebag County, Wisconsin My Commission Expires: Z• h PERMIT NOJ ■Z � . APPL . DATE . -9 --,S= ELEC. CONTR. c / OWNER / ADDRESS '� %�Q _ • NATURE OF WORK ELEC. SERV. NEW DESC. TYPE �� TEMP. FIX'S /�C` SW'S VOLTS AMPS RECEPT'S DC CIRC'S G1 APPLIANCES SIGNS INSP. ROUGHIN LUf'(' -i -53 SERVICE FINAL / /►�i, EST. COST © PERMIT FEE DATE PD 3--3 9 3 REMARKS