HomeMy WebLinkAbout0157222-Electric (fuel dispensers) � CITY OF OSHKOSH No 157222
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 2167 STATE ROAD 44 Owner QUENTIN/MARY GERLACH Create Date 08/15l2013
Contractor TEAM SERVICES INC Category 643-Commercial-Addition/Remodels Plan
Inspector Adam Krause
Service p New � Change � Temp � N/A I Type � Overhead � Underground I
Volts Circuits Luminaires
Amps Switches Receptades
Appliances
Use/Nature of OMM\Replace existing fuel dispensers-wiring i
Work
�
Fees: Valuation $2,000.00 Plan Approval $0.00 Permit Fee Paid $87.00
Issued By: Date 08/15/2013
� Permit Voided'I Parcel Id# 1329430200
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 2602 AMERICAN DR APPLETON WI 54914 -9010 Telephone Number (920)738-5885
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.
Ciry of Oshkosh
Division of Inspection Services �
P.O.Box 1130 �
Oshkosh,WI54903-1130
Phone(920)236-5050
Fax (920)236-5084 "(�, ���,�.}. ''7 r �/ O--fHKO H
1 �lJ I �UI->i'i' l� LD lD oni rr�F„r�TF�
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 54903-1]28. Commencing work without permit(s) wil] result in fees being doubled or$100.00 plus the
normal permit fee, which ever is greater.
OR
�f vou are a contractor pqrticipalinp in the Permit Fee Account SYstem and have adequate jirnds check here
t(l�ou wan� Ihis processed throu,gh vour account ❑
DATE
JOB ADDRESS I �
OWNER_�i���
CONTRACTOR I P am 4�e�'�,� � ('P� �Y1C
CHECK� ALL APPLICABLE
USE CATEGORY
❑Single Family ❑Duplex ❑Multi-Family ❑Rental l�Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE ❑Overhead ❑Not Applicable
❑Change ❑Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts / Receptacles# Circuits #
Phase
Amps Switches# Fixtures#
CHECK� ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower ❑Furnace ❑A/C ❑Electric Sign
�Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE_�Q �0 j/�S�- 2yc ; 3 1.' ,,� �v��
�i s A e,� s en g . �
VALUE (Including labor and all materials incl ding light fixtures) �d��. Ob `-� �7• V Q �Ce.
MASTER ELECTRICIAN
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