HomeMy WebLinkAbout0096706-Electric (lunch room receptacle) / CITY OF OSHKOSH No 96706
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 3465 MOSER ST Owner CENTRACOR INC Create Date 08/19/2002
Contractor WITZKE ELECTRIC Category 653 - Industrial- Addition /Remodels Plan
Service 0 New O Change 0 Temp Type 0 Overhead 0 Underground
Volts 120 Circuits 2 Fixtures 0
Amps 20 Switches 0 Receptacles 4
Appliances
Use /Nature of IND/ Provide & install rec in lunch room.
Work
Fees: Valuation $500.00 Plan Approval $0.00 Permit Fee Paid $20.00
Issued By: C v Date 08/19/2002
Permit Voided
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address PO BOX 102 155 E PACKER AVE OSHKOSH WI 54903 - 102 Telephone Number 920 - 235 -6572
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903 -1130
Phone (920) 236 -5050
Fax (920) 236 -5084 O /HKOJH
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 ❑ Q
M DATE O 1 r. °
JOB ADDRESS 3 96,5 D (QS t) `
OWNER Q CJ Ra ? Qr 4 c1/4 v k ct JS .L'—
CONTRACTOR W i + E(ec+riG 1 '10.
CHECK H ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial afindustrial
SERVICE ❑New ❑Temporary TYPE ❑Overhead VSNot Applicable
❑Change r' Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER •
Volts /off / Receptacles # Circuits # a
Phase /
Amps a-d Switches # Fixtures #
CHECK Ef ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower ❑Furnace ❑A/C ❑Electric Sign
DMotors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK DONE e {'o J ■ e * Z \Jc. ( ( "
.—/
■."..e_ - _c.9
VALUE (Including labor and all m r ...._
_ _ fixtures) $ J �
I
MASTER ELECTRICIAN IVA *
1
116, , r '��'"�'
6 # a°
3/02