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� CITY OF OSHKOSH No 155934 €
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 2009 JACKSON ST Owner STD PROPERTIES LLC Create Date 05/10/2013
Contractor ELECTRICAL SERVICES Category 643-Commercial-Addition/Remodels Plan
Inspector Adam Krause
Service New � Change � Temp � N/A Type � Overhead � Underground �
Volts Circuits 20 Luminaires 50
Amps _ Switches 6 Receptacles 125
Appliances Fumace,A/C, Electric Sign
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Use/Nature of OMM FAST-N-EASY PAWN SHOP)/INTERIOR ALTERATIONS FOR NEW TENANT '�check#2036
Work
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Fees: Valuation $5,400.00 Plan Approval $0.00 Permit Fee Paid $155.00
Issued By:���� ' ' Date 06/03/2013
� Permit Voided I Parcel Id# 1219090000
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 sec any necessary approvals before starting such activity.
Signature �' �/ ��rG�<<,�� S��-(/�c f 5 Date 6` 3 � �3
AgenUOwner
Address N4696 VINE RD FREEDOM WI 54130 -7331 Telephone Number (920)920-585-4000 _
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.
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City of Oshkosh
Division of Inspection Services �
P.O.Box 1130 �
Oshkosh,WI 54903-1 1 30
Phone(920)236-5050
Fax (920)236-5084 O.IHKOf H
ON THF 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 ar 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
�you are a contractor participatinQ in the Permit Fee Account Svstem and have adequate fzsnds check here
ifvou want this processed through vour account ❑
DATE 6-� -a� �3 .
JOB ADDRESS a70�9 �T�e�so v S�•
OWNER FA-sf E�y ��''^�
CONTRACTOR ��c f��<<-� Se�clrc�s�
CHECK 0 ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental �ICommercial ❑Industrial
S�RVICE �New ❑Temporary TYPE ❑Overhead �Not Applicable
❑Change �Not Applicable ❑Underground '
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles# ��2S Circuits# �
Phase /
Amps Switches# b Fixtures# -sa
CHECK�ALL APPLICABLE
❑Range ❑Dishwasher ❑�arbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower H�urnace �7A/C L�1Electric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE
VALUE(Including labor and all materials including light fixtures) $ � YD 0
MASTER ELECTRICIAN
3/02
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