HomeMy WebLinkAbout0013700-Electric (service change) CII-6) CITY OF OSHKOSH No 13700
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC r PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 0 C s�� hi 61a PLAN NO.
OWNER �I A 4 t3
DESIGNER �
USE /NATURE OF WORK nn (V( 06P e 3 ‘C)
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 / 1W 4.. lb /G C /
Electric Serv. New ❑ Change g( Temp ❑ Type ) LVoltsjL2%r) Amps AGO
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
c o /
FEES: Valuation $ e p ` Permit Fee Paid $ � ✓ Park Dedication $
�.J t,
ISSUED BY �� i� /��� �_ � Date `�� ��7 Final/O.P. / '" 3 0 - F7
In the performance of thi o I agree to perform all or pursuant to rules governing the described • • ruction.
SIGNATURE
MH 4 r
A EN /O R DATE
ADDRESS
TELEPHONE #
PERMIT NO. / } 7 ,e PI,.. DATE _ 3 - F/
ELEC. CONTR. C; /�11
OWNER O jV _
if ADDRESS / / / — 0) \-e-
NATURE OF WORK
ZaLEC. SERV. NEW CHANGE ,. ..„ TEMP.
DESC. TYPE "3- 6 ./ ?� VOLTS J ..,- `la AMPS / o 0
FIX'S SW'S RECEPT' X CIRC'S X'
APPLIANCES V
SIGNS 6 eJ
INSP. ROUGHIN SERVICE& 3C- ? FINAL - 31.,61
EST. COST Lrf!) 0 -` PERMIT FEE..ZO - DATE PD .6 7-2f7
REMARKS
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