HomeMy WebLinkAbout0155763-Electric (knob & tube) � CITY OF OSHKOSH No 155763
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 247 W 12TH AVE Owner MARY C RETZLOFF Create Date 05/22/2013
Contractor ACTION ELECTRIC Category 612-Residential-Single Family Addition/R Plan
Inspector Adam Krause
Service New � Change � Temp � N/A � Type � Overhead � Underground
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Volts Circuits Luminaires
Amps Switches Receptacles
Appliances — ,
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Use/Nature of FR/KNOB AND TUBE '*check#3411 —
Work �
Fees: Valuation $588.00 Plan Approval $0.00 Permit Fee Paid $38.00
Issued By: �(,J Date 05/22/2013
❑ Permit Voided I Parcel Id# 0901290000
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 3061 W ELBERG AVE APPLETON WI 54914 -5734 Telephone Number (920)734-4020
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 Secu�e(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 3�
Division of Inspection Services �
P.O.Box 1130 �
Oshkosh,WI 54903-1130
Phone(920)236-5050 ��
Fax (920)236-5084
. QN TNF WHTPR
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$100.00 plus the
normal permit fee,which ever is greater.
OR
If vou are a contractor participating in the Permit Fee Account Svstem and have adeguate funds check here
if vou want this Drocessed throuph your account ❑
DATE J " ���-7
JOB ADDRESS o��I� I�J� I��' �'�
OWNER � � (lc.�F zl� � IZECEIVED
CONTRACTOR �t-`f�ul� ��c C�1--�G MAY 2 2 2013
CHECK C�1 ALL APPLICABLE DEPART�IE�7 OF
C0�9�tU\IT4'GE�'ELOP�IEVT
USE CATEGORY iNSPECI'10�SERVicF�nr�•tsiov
C�ingle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
SERVICE ONew ❑Temporary TYPE ❑Overhead ❑Not Applicable
❑Change ❑Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles# Circuits#
Phase
Amps Switches# Fiztures#
CHECK H ALL APPLICABLE
ORange ODishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
DFan OR Blower �Furnace ❑A/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other :
DESCRIPTION OF ALL WORK BEING DONE f�r+-� � �- �✓�
QG
Q� �
VALUE(Including labor and all materials including G t fixtures)$ J �
MASTER ELECTRICIAN � � Yd
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