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CITY OF OSHKOSH N9 32930
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC 'PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / ( 4 ( lK PO W SA . PLAN NO.
OWNER 6S-P j dSkk S .
DESIGNER
USE /NATURE OF WORK MOO 5 ii - 6 O 1)
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent p Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR cS Z- --/I ',
Electric Serv. New ❑ Change J' Temp ❑ Type . ?L&) Volts act 0 Amps (0 0
()
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
— BT _ Wig Disp — WSoft — CBasin
— Lav _ Sh DW DF San. Sewer
- WC _ FDr _SP Ur _ Storm Sewer
- Sink _ LTub Eject — SS _ Water
Other
FEES: Valuation $ S C3` Permit Fee Paid $ Z(10° ✓ Park Dedication $
ISSUED BY Date 3 -7- _ , !...' Final /O.P./ Z S /
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE / Z-i 1Z--g“ 3 - - / L�
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
Electrical Inspection Departme
Oshkosh, Wisconsin
Certificate of Electrical Inspection
This is to Certify, that the Electrical Work Installed by 7
in the premises of
at No.
is approved under an ordinance entitled, "An ordinance regulatin the installation of electric work,
electric wiring and apparatus in the City of Oshkosh."
Dated
Electrical Inspector
PERMIT NO. 3 7 ,APPL. DATE /
ELEC. CONTR. _ a f
OWNER L ✓, J
J i Of
ADDRESS / / p, —
NAURE OF WORK
-�:� — _ -
EL�C. SERV. NEW .�, •- 3 C ----- -- - ��
yp CHANGE r" TEMP.
DESC. T
'J ` w - d VOLTS / - ' '-f AMPS l'' D
FIX'S ! SW' S ( > \- RECEPT' S
APPLIAN S CIRC'S
SIGNS )
NSP. ROUGH N SERVICE - _ - /,-9L ail -'f
EST. COST 3 S4 PERMIT FEE .C9 .� •
REM DATE PD.� -9
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