HomeMy WebLinkAbout0157358-Electric (service change) � CITY OF OSHKOSH No 157358
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1102 WINDSOR ST Owner MATTHEW A BERTRAM Create Date 08/16/2013
Contractor VAN ERT ELECTRIC CO INC Category 634-Residential-Service Change Plan
Inspector Adam Krause
Service New � Change � Temp � N/A I Type � Overhead � Underground
Volts 120l240 Circuits _ Luminaires
Amps 100 Switches Receptacles
Appliances -
Use/Nature of SFR/SERVICE CHANGE to gain clearance over garage
Work
� �
Fees: Valuation $450.00 Plan Approval $0.00 Permit Fee Paid $30.00
Issued By: Date 08/21/2013
❑ Permit Voided I Parcel Id# 1310000000
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 2000 PROGRESS WAY KAUKUANA WI 54130 -9562 Telephone Number (920)766-3888
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 pertormed within two business days from the time the project is ready.
City of Oshkosh
Division of Inspectiou Services �
P.O.Box 1130 �
Oshkosh,WI54903-1130
Phone(920)236-5050
Fax (920)236-5084 O �VO �
1`
ON THF WA7ER
ELECTRICAL PERMIT APPLICATION
All infom�atinn after bold categories must be provided.
Incomplete applications will not be pracessed.
• 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$100.00 plus the
normal permit fee,which ever is greater.
OR
l�vou are a contractor participoting in the Permit Fee �4ccount Svstem and have adequate funds check here
if vou want this processed throuQh vour account ❑
DATE ��� �/�
JOB ADDRESS �� ! �
OWNER �
CONTRACTOR � Y � � \�
CHECK�J ALL APPLICABLE
�US CATEGORY
mgle Family ❑Duplex OMvlti-Family ❑Rental ❑Commercial DIndustrial
SERYICE ONew ❑Temporary TYPE �verhead ONot Applicable
C7Change ONot Applica.ble DUnderground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles# Circuits#
Phase
AmPs Switches# F��y�
CIiECK�ALL APPLICABLE
��$e �Dishwasher OGarbageDisposal . ❑Dryer ❑WaterHeater
❑Fan OR Blower OFurnace DA/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE
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VALUE(Including labor and all materisls includIng light t"iztures) ���` v CJ
MASTER ELECTRICIAIV
�'�/ ���r ` � 3/02