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� CITY OF OSHKOSH No 156774
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1915 FABRY ST Owner MARY ANN V DEDOW Create Date 07/18/2013
Contractor FAITH TECHNOLOGIES, INC. Category 634-Residential-Service Change Plan
Inspector Adam Krause
Service � New � Change � Temp � N/A Type � Overhead � Underground ;
Volts 120/240 Circuits Luminaires
Amps 100 Switches Receptacles
Appiiances '
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UselNature of SFR\Replace 32 ckt.panel
Work
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Fees: Valuation $1,200.00 Plan Approval $0.00 Permit Fee Paid $87.00
issued By: , Date 07/18/2013 �
❑ Permit Voided!� Parcel Id# 1412390000
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 PO BOX 260 MENASHA WI 54952 -260 Telephone Number (920)738-1513
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 54903-1 1 30
Phone(920)236-5050 ���.;—;,--;
Fax (920)236-5084 �,�,���,�,��_f�-I, :
c,n;rrEF i+3a'rf�i .
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 Wl 54903-1 1 28. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the
normal permit fee,which ever is greater.
OR
1 Ott (IrN u ct�nlrticiUr�ar�licit�a(ir►g in the f'ernri! C�ee �fcc��urtt 5ystem ar•�'hati�e trde�rtu�e fuxcic. rheck here
�vou want this�rocessed through vour account ❑
oAT� ��0 � I'�ED
JOB ADDRESS I '� � L' �-� �✓��"�-�-~'4�``"'
owNFU � >c,� � JUL 18 2013
C{)NTRACTOR c•]`^-� `a- - �"`� t'� ��'�A-'n-f�'� DEPART1�tE\T OF
V C0�1JiU\ITY DEVELt���srvT
IVSPECTiOti SER�'ICES llt�;S1C)Y
CHECK�ALL APPLICABLE
US ATEGORY
ingle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE C�verhead ❑Not Applicable
BC�ange ONot Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE HUMBER '
Volts / Receptacles# � Circuits# J
Phase
Amps /�Y Switches# � Fixtures# �
CHECK�ALL APPLICABLE
�Range ❑Dishwasher ❑GarbageDisposal ODryer ❑WaterHeater
❑Fan OR Blower ❑Furnace ❑A/C ❑Electric Sign
❑Motors OGas Pumps ❑Other
DESCRIPTION OF ALL WORK BE[NG D(}NF
--�1[l--�Q..4....3 ���-C�.� �t�..'t._�.�} ( �Q?J Gt-u. ,U ,
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VALUE(Including labor and all materials including light fixtures)$ ����
MASTER ELECTRICIAN���C �t-.--�t;!1,�-�-�-����' �
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