HomeMy WebLinkAbout0145573-Electric CITY OF OSHKOSH No 145573
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1722 MINNESOTA ST Owner STEVEN /AMANDA SEEGERS Create Date 04/21/2011
Contractor HOMEOWNER Category 612 - Residential - Single Family Addition /R Plan
Service (,� New n Change ;; Temp 0 N/A Type 0 Overhead Underground
Volts Circuits Luminaires
Amps Switches Receptacles
Appliances
Use /Nature of SFR\ gutting and remodeling bathroom. All work shall comply with current code.
Work
Fees: Valuation $500.00 Plan Approval $0.00 Permit Fee Paid 525.00
Issued By "7776
Date 4/21/2011
Permit Voided Parcel Id # 1403790000
The undersigned, in applying for an Electric Permit to perform electrical work within a single family home, owned and occupied
as the principle residence by the undersigned, hereby acknowledges per City Municipal Code Section 11-22, that other
individuals may not be employed to assist with the work described in this perm it unless said individuals are licensed by the
City of Oshkosh to perform said work.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction
While the City of Oshkosh has n• authority to enforcee-- !ement restrictions of which it is not a party, if you perform the work
described in this permit ap• '.%on , . tin an ea,,; .- . • - ity strongly urges the permit applicant to contact the easement
holder(s) and to sec • a y-*: before.$tarting such activity.
Signature "- Date 4r■ / ?-1, .' i/
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
Oshkosh, WI WI 54903-1130
410)
Phone (920) 236 -5050
Fax (920) 236 -5084 O.f HKOf H
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 ❑
DATE //p h 1 al , i/
JOB ADDRESS 1 7 ' minrt S 1-
OWNER 57 d Ag �Y 7 •
CONTRACTOR
CHECK ALL APPLICABLE
U E CATEGORY
Single Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE ❑Overhead ❑Not Applicable
❑Change ❑Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles # Circuits #
Phase
Amps Switches # Fixtures #
CHECK la ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer DWater Heater
:Wan OR Blower ❑Furnace DA/C DElectric Sign
DMotors ❑Gas Pumps ❑Other !» h
DESCRIPTION OF ALL WORK BEING DONE .
VALUE (Including labor and all mate ' !'s including light f . e"• s) $ 0
MASTER ELECTRICIAN /� i/
3/02