HomeMy WebLinkAbout0146793-Electric (low voltage) 0 CITY OF OSHKOSH No 146793
OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 855 N WESTHAVEN DR Owner AURORA MEDICAL CENTER OF OSHKOSI Create Date 07/13/2011
Contractor CC & N 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 Low voltage Teledata / Wall penetration and fiber pathway MOB N/W to H808720C Communication Closet. * *debit acct
Work
Fees: Valuation $2,000.00 Plan Approval $0.00 Permit Fee Paid $77.00
Issued By: �y/ Date 07/13/2011
El Permit Voided Parcel Id # 1621520000
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 N27W23588 PAUL RD PEWAUKEE WI 53072 - 5790 Telephone Number (920) 830 -6706 (Don)
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.
07/13/2011 07:29 '3208306725 CC &N PAGE 01/01
Division ion of Oshkosh
vii of Inspection Services
P.O. O
Box 1130
Oshkosh, WI 54903 -] 130
Phone (920) 236 -5050
Fax (920) 236-5084 .LS H
ON THE HATER
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 pemmit(s) will result in fees being doubled. or $1100.00 plus the
normal: permit fee, which ever is greater.
OR
If you are a c in the Permit Fee Account System and have adequate. funkis. check here
if you want this processed through your accou t 0
DATE - 7/13/2011
JOB ADDRESS - 855 North Wcsthavcn
OWNER - Aurora Oshkosh Medical Center
CONTRACTOR - CC &N
CHECK El ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex :Multi-Family °Rental X Commercial ❑Industrial.
SERVICE UNew OTemporary TYPE ❑Overhead ❑Not Applicable
❑Change ❑Not Applicable DUr d.erground. ❑Undergrothnd
FILL IN TIIE APPROPRIATE BLANK WITH 'THE NUNII3ER
Volts / Receptacles # 0 Circuits #
Phase
Amps Switches # Fixtures #
C.HF,CK Pi ALL APPLICABLE
❑Range ❑Dishwasher OGarbage Disposal ❑Dryer ❑WaterlHeater
DFan OR Blower ❑Furnace ❑A/C ❑Electric Sign
❑Motors CIGas Pumps ❑Other - Teledata
DESCRIPTION OF ALL WORK BEING DONE -
Wall Penetration and Fiber Pathway MOB N/W to H 808720C Communication Closet
Permit Fee amount — $77.00
VALUE (Including labor and all materials including light fixtures) 81 „000 - $2,000
MASTER COMMUNICATION - Donald G. Folger
Received Time Jul. 13. 2011 7:40AM No. 6327 3/02