HomeMy WebLinkAbout0004276-Electric (garage) 46) _CITY OF OSHKOSH N2 04276
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC X PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 9/t- PLAN NO.
OWNER o, °141-7474-
DESIGNER
USE /NATURE OF WORK �(y� /
•
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 _ ' `
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures X. Switches V---..- _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 $ , (� *3/07•--. �.�
Permit Fee Paid $ ` Park Dedication $
ISSUED BY /// 4 - %1 Date 6 `a 02 — 72 Final /O.P. 02 -Ito -23
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
�+ /
SIGNATURE ! _ � � � I 4 ,. E 7
� f AGENT/OWNER DATE
A DDRESS ‘1411 �3/ 6(.1-
TELEPHONE #
AFFIDAVIT P T-ATING 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 )
i■ saw U. l e-ir S
(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.
Atfiant 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 c2 c1 day of -J u. v3 ( , ,
Subscribed and sworn to before 1
this , day of 19.
Notary Public, Winnebago County, Wisconsin
My Commission Expires: R 15 )
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PERMIT NO. D PL. DA E
ELEC. CONTR. / r
OWNER �/ _
ADDRESS G / l 0-(4-r--e-=-7 NATURE OF WORK LA_ /4)- -e ms -
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S SW'S (2( _ RECEPT'S JC■ CIRC'S
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE
EST. COST Q c. - PERMIT FEE „...V% PD. -87
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