HomeMy WebLinkAbout0046071-Electric (service change) &3Y
CITY OF OSHKOSH
NS! 46071
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC)( PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
/
ADDRESS / 9 PLAN NO.
OWNER �`AC -L. 9 ' /
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 rCe>
Electric Serv. New ❑ Change ,(Temp ❑ Typeqff Volts 314) 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 $ 5b d 0 Permit 2 - 0 c7
� // t Fee Pa $ Park Dedication $
ISSUED BY - ,.li��C-C�Z--- Date �
��/ Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR 'Or / / >&11111°,0
' 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)
61444.11_
/ de /d
(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 purposes 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 t) u- / , 19iY
/-7
'9 7
Subscribed and sworn to before
this day of , 19_.
Notary Public, Winnebago County, Wisconsin
My Commission Expires:
103
PERMIT NO. "' APPL. DATE 7 /r /9<r
ELEC. CONTR. AeNt)4
OWNER
ADDRESS I / 0 (so rr -s►--
NA`i'URE OF WORK
ELC, SERV. NEW CHANGE TEMP '
PESC. TYPE VOLTS AMPS
FIX'S SW ' S RECEPT'S CIRC'S
APPLIANCES
SIGNS FINAL
EST COST 3-0-0 INS.. OTGHIN PERMIT FEM../ DATE PD .77/0 V .--
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