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CITY OF OSHKOSH N ° - 44318
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECT PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS gip! E bile, PLAN NO.
OWNER OA 1 C R- c - t.1
DESIGNER
USE/NATURE OF WORK CS t . 1 4 LL IN
- C-1 k' L. --E-j
U 'a- - \Eta \S -Lt (ST-F- LCZ � -- LJGL- - TM^tLy i
Cap. +(zc:CIA) 0 L.1 t1 X I ■ ST-111L .)
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ NC ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR r)--t— l■le
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 $ V Permit Fee Paid $ /�' /
Park Dedication $
ISSUED BY Date 3/20/95
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATUR i .,>
A(3 UO R ' /
6// , / n 6.5// DATE
ADDREL r K- /, si 46 - &49 y'
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 )
�kCD\ , E
(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.
Afflant understands that the electrical worts authorized by
the permit applied for in connection with this affidavit, must
be done only by this afflant and that he cannot employ others to
assist with the electrical words but members of his immediate
family.
Dated this d of Jt/k {rCec _A , 19=
AciXA /2.44/v
Subscribed and sworn to before
this 30 day of � �� , 19 g.S.
Notary Public, Winnebago County, Wisconsin
My Commission Expires:
PERMIT NO. .APPL. DATE
ELEC. CONTR. 4.e>1G6{
OWNER // ( 1 .ft
ADDRESS 3i o I /'3 , ,
NATURE OF WORK
,. / ,,
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP. ROUGHIN � t'`-, "( SERVICE FINAL
EST. COST PERMIT FEE DATE PD.
REMARKS
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