HomeMy WebLinkAbout0001838-Electric (service change) CITY OF OSHKOSH N2 01838
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ) 1 4 PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / Z / * PLAN NO.
OWNER Are-1 ` i /
DESIGNER
r
USE /NATURE OF WORK 40elj,y2 /
i
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 ❑ Chang,42Temp ■ Type! — ' Volts /00
Fixtures Switches Receptacles Circuits a l/C:la
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
o s '
FEES: Valuation $ J, . Permit Fee Paid $ ` a Park Dedication $
ISSUED BY Date 16 — 3 6 ''?-6 Final /O.P. it' la - 3
In the performance of this agree to perform all work .ursuant to rules governing the described construction.
SIGNATURE r / 7 /o '3 4
AGENT /OWNER DATE
ADDRESS /,-I 5 C/v /w L 6.1-• L5)C /1 • ?5 6 St 0
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 )
A e 5 R-1 e /��h 42/ S /Yl G GV ►
(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.
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 /0 -30/- day of , 19 __.
Subscribed and sworn to before
this , & 1/1 '‘' y of OoLlo Q , 19 VO
1 49 a l.'t °4a.a
Notary P c, Winnebago County, Wisconsin
My Commission Expires: 35
•
Electrical Inspection Department
Oshkosh, Wisconsin
Certificate of Electrical Inspection
This is to Certify, that the Electrical Work Installed by '/1/4 p�
in the premises of ' °<*J
, ,.`' at No. /t r"
is approved under an ordinance entitled, "An ordinance regulating the installation of electric work,
electric wiring and apparatus in the City of Oshkosh."
Dated
,14 ,.. / 7 7
Flea IInspector
PERMIT NO.6 L: 1d v i * PL. DATE
ELEC. CONTR.
OWNER
ADDRESS / /, 5'-94
NATURE OF WORK
ELEC. SERV. NEW CHANGE'` TEMP.
DESC. TYPE 7 -- 3 d 3 - tt.- VOLTS / AMPS le 0
FIX'S SW'S RECEPT'SK CIRC'S
APPLIANCES
✓ ,
SIGNS
INSP. ROUGH N _ SERVICEL f FINAL
3S
EST. COST ® PERMIT FEE SATE PD/GL- - ,-S,
REMARKS
(A00-‘)