HomeMy WebLinkAbout0154200 - Electric (temp power) CITY OF OSHKOSH No 154200
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 801 SIEWERT TRL Owner CITY OF OSHKOSH(PARKS) Create Date 01/18/2013
Contractor SUBURBAN ELECTRICAL ENGINEERIN' Category 643-Commercial-Addition/Remodels Plan
Inspector Adam Krause
Service • New 0 Change 0 Temp • N/A ] Type 0 Overhead O Underground
Volts Circuits Luminaires
Amps Switches Receptacles
Appliances - — —
Use/Nature of ''COM\Temp power for Otter Street Club event
Work
Fees: Valuation - ---- — —-— ----- —- ----- - --
o $100.00 Plan Approval $0.00 Permit Fee Paid $30.00
Issued By: `crr
Date 01/18/2013
El Permit Voided Parcel Id#
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 709 N HICKORY FARM LN APPLETON WI 54914 -3032_ Telephone Number (920)739-5156
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
Phone(920)236-5050
Fax (920)236-5084 011—K01H
ON THE WATFR
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$100.00 plus the
normal permit fee,which ever is greater.
OR
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if you want this processed through your account ❑
DATE lb J i i
JOB ADDRESS M it.Lea5 ?,/3-t - k4'�r .. €- Praa.iL
OWNER O1742 51 R fq T r;S,4 ;ti5 Ct.,JI
CONTRACTOR 5 bur bet)1 /f('--1 l l C---,
CHECK 0 ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Dupllex ❑Multi-Family ❑Rental Ilkommercial ❑Industrial
SERVICE ❑New Elfemporary TYPE DOverhead ❑Not Applicable
❑Change ❑Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles# Circuits#
Phase
Amps Switches# Fixtures#
CHECK El ALL APPLICABLE
ORange ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
DFan OR Blower ❑Furnace DA/C DElectric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE ptvJ'7 -for e V
VALUE (Including labor and all , + ' Is including light fixtures)$ ' 00.D 0
MASTER ELECTRICIAN "° (3vI8'V
3/02