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CITY OF OSHKOSH No 145098
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2030 SHERIDAN ST Owner MARK M HEUCHERT Create Date 03/08/2011
Contractor HOMEOWNER Category 634 - Residential- Service Change Plan
Service 0 New • Change (; Temp 0 N/A Type • Overhead 0 Underground
Volts 120/240 Circuits Luminaires
Amps 100 Switches Receptacles
Appliances
Use /Nature of SFR\ Wiring for new jacuzzi tub. Service change to add breaker space. All work to meet current cede requirements
Work
Fees: Valuation $400.00 Plan Approval $0.00 Permit Fee Paid _ °? $25.00
Issued By: //IX . Date 3/8/2011
1 Permit Voided Parcel Id # 1213030000
The undersigned, in applying for an Electric Permit to perform electrical work within a single family home; owned and occupied
as the principle residence by the undersigned, hereby acknowledges per City Municipal Code Section ill-22, that other
individuals may not be employed to assist with the work described in this permit unless said individuals are licensed by the
City of Oshkosh to perform said work.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this per application within an -asement, the City strongly urges the permit applicant to contact the easement
holder(s) and to s e an ecessary - -, oval .efor- rting such activity.
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Signature y / /c C. Date 3_
Agent/Owner
Address OSHKOSH WI 5490 - 0000 Telephone Number
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
Phone (920) 236 -5050
Fax (920) 236-5084 OfHKOJH
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 $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if you want this processed through your account ❑ )
l� DATE S g l /
JOB ADDRESS ( 4< Ikeo
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OWNER s �1'r t 4a1�
CONTRACTOR 0 k//14..0
CHECK BI ALL APPLICABLE
USE CATEGORY
7$ingle Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE , Overhead ❑Not Applicable
`OChange ❑Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts (a& /'-0 Receptacles # Circuits #
Phase
Amps / 0 P Switches # Fixtures #
CHECK ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower ❑Furnace DA/C DElectric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE fr\l l J QLU Jed- r
I : GI% n e f° 0 /-fir -- dam
VALUE (Including labor and all ma - als luding lig fixtures) $ 4DO
MASTER ELECTRICIAN • / /S
3/02