HomeMy WebLinkAbout0030022-Electric CITY OF OSHKOSH N°- 30022
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC% PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS z 'r3 5 ��� PLAN NO.
OWNER $2' ' JGC! /
DESIGNER
USE /NATURE OF WORK/f.
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 ne.i> tfi- //Lt c . /dr U! Zt-Griic 1, -
Electric Serv. New ❑ Change ❑ Temp ❑ Type ( Volts / 2_o Amps 7
Fixtures 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
FEES: Valuation $ SO f 0 0 Permit Fee Paid $ / 0 0 / Park Dedicatio $
ISSUED BY Date oh 2----- Final /O.P. C i,2/V
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Q "' '
AGENT /OWNER DATE
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 )
62ev :1/2/35"
(Name) (Address)
first being duly sworn on oath, deposes and says that he 1s 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 S
day of ax.7 , 19.z.
s i pp, L ,_ 63,,,,,..ei---
Subscribed and sworn to before
this . c5 day , f (ir , 19 -.
' 6; ?
Notary ublic, Winnebag County, Wisconsin
My Commission Expires: Vic-.. 3 /95
•
i
PERMIT NO. 272 " , AP - DATE I J Y
ELEC. CONTR. _
OW_N,ER / / �_ e
/ /
ADDRESS 29.5 - �-�- -
NATURE OF WORK O
`_14 -all i /
.5LEC. SERV. NEW CH ik TEMP .
DESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'§ CIRC'S
APPLIANCES
SIGNS ) `
INSP. ROUGHIN SERVICE FINAL Y -L 7)
EST. COST 5" e) PERMIT FEE /0 - DATE PD 5 2
REMARKS