HomeMy WebLinkAbout0153190 - Electric (replace CT Simulator) CITY OF OSHKOSH No 153190
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Owner MERCY MEDICAL CENTER OSH INC Create Date 10/25/2012
Contractor VAN ERT ELECTRIC CO INC Category 643-Commercial-Addition/Remodels Plan _
Inspector Adam Krause
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/Replacing the CT Simulator. **check#4014
Work
Fees: Valuation $10,000.00 Plan Approval $0.00 Permit Fee Paid $213.00
Issued By: ,��)(„�} Date 10/25/2012
l ❑ Permit Voided I 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 2000 PROGRESS WAY KAUKUANA WI 54130 -9562 Telephone Number (920)766-3888
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
Phone(920)236-5050
Fax (920)236-5084 OJHKEDJH
ELECTRICAL PERMIT APPLICATION ON THE WATER
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
you .want thi processed through your account ❑
DATE /r/S/
JOB ADDRESS Soo 5• OAKI.Jc,rp Rot
OWNER A i--1---1Ai
CONTRACTOR VA iu 6It s 64-6 LTA (
CHECK B ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental 6Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE DOverhead
❑Change ❑Not Applicable ONot Applicable
❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles #
Phase Circuits#
Amps Switches #
Fixtures#
CHECK Q ALL APPLICABLE
❑Range DDishwasher ❑Garbage Disposal ❑D er
❑Fan OR Blower DFurnace ❑A/C �' DWater Heater
❑Motors ❑Gas Pumps Daher ❑Electric Sign
DESCRIPTION OF ALL WORK BEING DONE CO ,/∎,&J G- :;.,t AA_=.,✓ CT Sim Uk/i TuR
Z11i' Tthl: CHWCc: R
VALUE (Including labor and all materi including light fixtures) $ /C, i5
MASTER ELECTRICIA — "
r- 3/02