HomeMy WebLinkAbout0154597 - Electric (smoke detector) 0 CITY OF OSHKOSH No 154597
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Owner MERCY MEDICAL CENTER OSH INC Create Date 03/01/2013
Contractor VAN ERT ELECTRIC CO INC Category 643-Commercial-Addition/Remodels Plan
Inspector Adam Krause
Service �ew 0 Change • N/A Type
- e 0 Temp Yp � Overhead 0 Underground
Volts Circuits
-- - --- Luminaires _
Amps Switches Receptacles
Appliances
Use/Nature of COMM/ADD DOOR HOLDERS&SMOKE DETECTOR OPA,RELOCATE LOWER LEVEL V/ON DOOR, REPLACE SHARED
Work RECOVERY TOILET ROOM DOOR INTERLOCK SYSTEM **check#4057
Fees: Valuation 41,480.00 Plan Approval $0.00 Permit Fee Paid $358.18
Issued By:
Date 03/01/2013
❑ 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 O f_�0 J�
• 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 54903-1 128. Commencing work without permit(s) will result in fees being doubled or$100.00 plus the
normal permit fee,which ever is greater.
OR
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if you want this processed through your account ❑
DATE Qf d0//
JOB ADDRESS 044 jam
OWNER /lc/9477F /-pcfedy / L
S/.D/7 L_
CONTRACTOR 1%J
CHECK E1 ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental %Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE ❑Overhead ❑Not Applicable
N/ ❑Change ❑Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles# Circuits#
Phase
Amps Switches# Fixtures#
CHECK El ALL APPLICABLE
ORange ❑Dishwasher ❑Garbage Disposal ❑Dryer OWater Heater
❑Fan OR Blower ❑Furnace ❑A/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE
`
'c.23 i� ir1t / �� /' ✓1 000/6- ln/7C7L G.r .c Cl
VALUE (Including labor and all materials including ugh fixtures)$ 4//¢B' ,
MASTER ELECTRIG � �� e6 I/ Alp iedi0
F--44/3
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