HomeMy WebLinkAbout0146355-Electric (operating room #7 renovations) 10 CITY OF OSHKOSH No 146355
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Owner MERCY MEDICAL CENTER OSH INC Create Date 06/14/2011
Contractor EXCELLENCE ELECTRIC Category 643 - Commercial- Addition /Remodels Plan
Inspector Kevin Benner
Service 0 New 0 Change 0 Temp • N/A Type 0 Overhead 0 Underground
Volts Circuits Luminaires
Amps Switches Receptacles
Appliances
Use /Nature of COMM / OPERATING ROOM #7 RENOVATIONS (Job #7057) "check #28077
Work
Fees: Valuat' $3,083.00 Plan Approval $0.00 Permit Fee Paid $111.00
Issued By: Date 06/14/2011
❑ Permit Voided Parcel Id # 0613660000
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 permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address PO BOX 78 LITTLE CHUTE WI 54140 - 78 Telephone Number (920) 687 -2442
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
4
Phone (920) 236 -5050
Fax (920) 236 -5084 01HK DJH
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 OA
JOB ADDRESS. ..2X) S• e7,44ezer7.0
OWNER 1/17 /j" 7 1-* _4 &
CONTRACTOR r7 CC�GW &:E'-772/ C ,
CHECK El ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi - Family ❑Rental Kommercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE ❑Overhead ,Not Applicable
❑Change Mot Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles # Circuits #
Phase
Amps Switches # Fixtures #
CHECK !71 ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower ❑Furnace ❑A/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE (Including labor and all rials including light fixtures) 0 oa
MASTER ELECTRICIAN aW
To8 7oS7
`72M/7 il °v 3/02