HomeMy WebLinkAbout0154872-Electric � CITY OF OSHKOSH No 154872
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1350 FAIRFAX ST Owner ANDREW R/LAUREN A CLAYTON Create Date 03/28/2013
Contractor HOMEOWNER Category 612-Residential-Single Family Addition/R p�an
Inspector Adam Krause
Service New � Change � Temp � N/A � Type � Overhead � Underground I
Volts Circuits Luminaires
Amps Switches Receptacles
Appliances
� I
Use/Nature of SFR\New 8'X 8'basement bathroom according to attached plan i
Work
Fees: Valuation $200.00 Plan Approval $0.00 PermitFee Paid $30.00
Issued By: �� Date 3l28/2013
�
a Permit Voided I Parcel Id# 1343020000
The undersigned,in applying for an Electric Permit to perform electrical work within a single family home,owned and occupied
as the principle residence by the undersigned,hereby acknowledges per City Municipal Code Section 11-22,that other
individuals may not be employed to assist with the work described in this permit unless said individuals are licensed by the
City of Oshkosh to perform said work.
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
AgenUOwner
Address OSHKOSH WI 5490- 7442 Telephone Number
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.
\��-� ����
�,��IVED
City of Oshkosh
Division of Inspection Services MAR 2 8 2013 �
P.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050 �"'� �`�'������
Fax 920 236-5084 COVII�[`,` : �}+rT-aPa1ENT
� � iNSPEC"+��.:,�:-'���C�S Dl�'ISIQ'v
ON TFfE WATER
ELECTRICAL PERMIT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
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• 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
IJvou are a contractor participati� in the Permit Fee Account Svstem and have adeguate funds. check here
�vou want this processed through vour account ❑
DATE��)�� 1� i—�
JOB ADDRESS ��." �V �Q),I�.�Cl1�--�,l.�S Y l ,�1�'� � �� ���
OWNER �—C1f`OU'�,f) t" L�-��(/l �X d
T'
CONTRACTOR J� ` I�- /(�1 1�115�
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CHECK�ALL APPLICABLE
U E CATEGORY
Single Family ❑Duplex ❑Multi-Family ❑Rental Commercial ❑Industrial
SERVICE�1�Tew ❑Temporary TYPE Overhead �Not Applicable
❑Change ONot Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts �a�N9`� Receptacles#� Circuits# ��
Phase � �
� Amps � Switches# Fixtures#.
CHECK C�1 ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
�an OR Blower ❑Furnace ❑A/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other
�}�� 3
DESCRIPTION OF ALL WORK BEING DONE (��Q� ��JI.LJ'li���V� (.I/l�.
Y ) �.7C V' �U( � ' C�9.YL �l 1�. r �l�A �� �l`�\l A I�_� �;\ n� �U: \tTi�h-� �11.A ,111 . >
� - -
VALUE(Including labor and all materials including light fiztures)���
MASTER ELECTRICIAN 1 t./ �
3/02
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