HomeMy WebLinkAbout0121916-Electric 0 CITY OF OSHKOSH No 121916
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 21 W 15TH AVE Owner KENNETH J/TAMMY L VERMEERSCH Create Date 10/04/2006
Contractor GROVER ELECTRIC Category 612 - Residential - Single Family Addition /R Plan
Service IQ New Q Change Q Temp 0 N/A Type 0 Overhead 0 Underground
Volts 120/240 Circuits 2 Luminaires 1
Amps 100 Switches 3 Receptacles 2
Appliances Fan
Use /Nature of SFR/ Bathroom remodel* converting part of the 1st floor enclosed porch into a full bath to serve the master bedroom and remodeling the
Work existing 2nd floor bathroom.
Fees: Valuation $480.00 Plan Approval $0.00 Permit Fee Paid $25.00
Issued By: ljfit Date 10/05/2006
❑ Permit Voided Parcel Id # 0305130000
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the Ci • _ • h has no authority to enforce easement restrictions of which it is not a party, if you perform the work
describ- • in this permit app' -tion within an eas- 11 _ • , - ity strongly urges the permit applicant to contact the easement
holder( -nd to s: ur . • - - - ary.= ,.prova -41,0 .re starting such activity.
Signatur -�_ ��� ` _ Date r0~ S d w
Agent/Owner
Address 1650 S OAKWOOD RD OSHKOSH WI 54904 - 0 Telephone Number 920 - 379 -7259
To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130
( 41 . IIP D
Phone(920) 236 -5050 O�O�H
Fax (920) 236 -5084
ON THE WATER
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed
•
. • • Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903 -1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
•
OR •
It you are a contractor participating in the Permit Fee Account System and have adequate funds. check here
if you want this processed through your account ❑
•
• DATE /() -5
JOB ADDRESS Ut / ,5 f'
OWNER JT r. i/ 54n
CONTRACTOR (ry
• CHECK H ALL APPLICABLE
USE CATEGORY
Single Family ❑Duplex ❑Multi - Family [Mental ❑Commercial ❑Industrial
•
SERVICE ❑New ❑Temporary TYPE ❑Overhead ❑Not Applicable
❑Change ONot Applicable ❑Underground -
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts 124) / z-s-& Receptacles # Z— Circuits # •
Phase s I t .
Amps (D U Switches # 3 Fixtures # I
•
CHECK El ALL APPLICABLE
•
tJRange ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
Wan OR Blower. ❑Furnace OA/C ❑Electric Sign
. OMotors OGas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE iSc roc.
•
VALUE (Including labor and all materials including light ���
� l; g g t fixtures) $
• MASTER ELECTRICIAN 10r, �`7 c--t� `` i 0
a
3/02