HomeMy WebLinkAbout0155771-Electric (temporary service) � CITY OF OSHKOSH No 155771
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OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3265 WHITE TAIL LN Owner MIDWEST GENERAL CONTRACTORS Create Date 05/22/2013
Contractor CUMINGS ELECTRIC INC Category 601 -Residential-Temporary Services Plan
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Inspector Adam Krause
Service New 0 Change � Temp � N/A � Type � Overhead � Underground �
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Volts 120/240 Circuits _ Luminaires
Amps 100 Switches Receptacles
Appliances - -
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UselNature of ULTI-FAMILY/TEMPORARY POWER TO NEW 6 UNITAPARTMENT *'debit acct -
Work I
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Fees: Valua'on $200.00 Plan Approval $0.00 Permit Fee Paid $30.00
Issued By: Date 05/22/2013
❑ Permit Voided I Parcel Id#
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perForm the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the easement
holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
AgenbOwner
Address PO BOX 749 NEENAH WI 54957 -749 Telephone Number (920)722-1240
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection(i.e. Footing,Service, Final,etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
y 2Z 2013 1 : 33PM HP LASERJET FRK p, i
� nivision o° =as�ction servicag
� 215 Church Aveuue
P.O. Box 1130 :
� Oehko9h. 1i� 5a903-1I30
E� �9a�) 236-5DB9
phoil� (920) �36-5046
EL$CTRICAL PERM=T APPLYCATION
A11 information sfter bold categoriee� muet be provided.
Incomplete applicatione will not be proceesed.
DATE 5/2 3
JOB ADDRES$ 3265 Whltetail Joe No. 8937-00
owtvER Midwest Gen ral
CONTRACTOR CUMIN S ELE TRIC IN ,
CFIECR ALL AppLICABLE
U88 CATE00&Y� SINQLE FAMILXQ DUPLEXQ MULTI-FAMILY� RENTAI,�
COMMERCIAL❑ INDUBTRZAL❑
S$RVICT: NEW � CHANGE ❑ TEMPORARY ❑ NOT APPI,ICABLE ❑ •
TYpE� OVERHEAb � UNDERGROU�TD � [�TOT APPI,I�gLE �
NQblHER OF �'IXTURES _ SWZTCHfiS _ RECEPTACLES _ CZRCUITB
AMPB 1QQ VOLT9 'I2_ 0/240 pHAAE �
CHECK ALL APPLICABLS
RANGE � WATFR F3EATER ❑ GARBAGE DISPOSAL ❑ DRYER ❑
DISHWASHER ❑ FAN OR HLOWER ❑ FURNp,CE [� A/C �
ELECTRIC sIGN ❑ MOTORS ❑ GAS PUMPS � OTHER
D�BCRIPTION OS 11LL WORPC HEINp DONB T o Power o 6-U 8� etlt
VALUS (rncludiag labor a�nd all matariale ia�luding liqhe fixtur�A) 2S� QQ,QQ
PBI�[IT d8t�
�s�►eTSR s=,�cTarc=Arr Rlcherd Wenzei
submit payment with application. Failure to pay within 30 d�ys will resu�t in
feee being doubled or $100.00 plu� the normal permit fee, which aver i� greater.
OR
Check here �f ou want th�Ie roceseed throu h our account �
#100-0750-2515-00000
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