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HomeMy WebLinkAbout0037839-Electric /v . ® CITY OF OSHKOSH N° 37839 PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC X PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ADDRESS .2Y--.1.5- PLAN NO. OWNER 0" "' 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 OG 4 7 ■.4t<< u ,, . Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps 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 FEES: Valuation $ co/40.p © Permit Fee Paid $ rs° b r Park Dedication $ ISSUED BY fri7t_ Date / /Zd /f y Final /O.P. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE 1 / AGENT /OWNER f DATE ADDRESS 7 Sher 'c/ i a C J � "l OS oS U 2— 1/( 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 ) A5).Atd 2.4a (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 worts but members of his immediate family. Dated this , a day o f , 19 9j . 4-PjW(/) Subscribed and sworn to before this day of ,, 1 9• Notary Public, Winnebago County, Wisconsin My Commission Expires: