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Home My WebLink About0046924-Electric (service change) CITY OF OSHKOSH NE 46924 PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELECX PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ADDRESS 17- 3 0 U ,iii-- PLAN NO. OWNER 2..f. joiai.--A-4--a 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 6L Electric Serv. New ❑ Change ( Temp ❑ Type 0/ / Volts? Amps fo a 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 1 FEES: Valuation $ C CO . J ° Permit Fee Paid $ . 7-41 ' a ''' - Park Dedication $ ISSUED BY ��7' Date / i Final/O.P. In the performance of this work I agree • perform all work pursuant to rules governing the described construction. SIGNATURE / / // ��% // h 5 AGENT /OWNER DATE ADDRESS ` f l l _a, 3 --- Ot,j 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) , j V (/ !/V e r �f (N (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 a1 day of a,(Oui..5 , 19 g-T 4 1' , Subscribed and sworn to before this day of , 19_. Notary Public, Winnebago County, Wisconsin My Commission Expires: PERMIT NO . � S Z / , APPL • DATE ELEC. CONTR. ©LeYv'•- OWNER 6a4414 ADDRESS / 23 O LA LaURE OF WORK ELEC. SERV. NEW CHANGE TEMP . DESC. TYPE VOLTS AMPS FIX'S SW'S RECEPT'S CIRC'S APPLIANCES SIGNS FINAL INSP. ROUGHIN SERVICE EST. COST Li 1-0 PERMIT FEE DATE PD . atztib REMARKS