HomeMy WebLinkAbout0004814-Electric (service change) CITY OF OSHKOSH N2 04814
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC,' PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / ., PLAN NO.
OWNER �
DESIGNER
USE /NATURE OF WORK l ./4
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
l
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change Temp ❑ Type Volts ` Amps "' 2-69
Fixtures t Switches Receptacles its a 41,
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
O
FEES: Valuation $ ; d Permit Fee Paid $ j '-' Park Dedication $
ISSUED BY •�� /2 % %%f Date —� — �7 Final/O.P. �� -��
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE e —S cp
�� AGENT /OWNER DATE
ADDRESS v <:=.1.,3 / -effla 1
TELEPHONE #
AFFIDAVIT RELATING TO SECTION 13.12 (e) OF A GENERAL ORDINANCE
-OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN).
) SS
WINNEBAGO COUNTY )
2,�,z x.)
Tr' (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.
APfiant 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 V' day of /4, sr , 19 .
��
Subscribed and sworn to before
this F
(iN /h) g . ,(1
Notary Public, Winnebago County, Wisconsin
My Commission Expires: 3 -e9
•
PERMIT NO di 7( 9 A•PL. DATE
ELEC. CONTR. a 4 -
OWNER
ADDRESS / - 'h
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE 3 - (Q O VOLTS / 4 AMPS.z
FIX'S L - SW's Ca, RECEP S c><__ CIRC' SK
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE' - -/ 'FINALS
EST_ COST 5r_5 " PERMIIT FEE3 -6 " DATE PDV'5
REMARKS
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