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� CITY OF OSHKOSH No 158118
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1605 RIVER MILL RD Owner CHANDRALEKHA BOMMAKANTI Create Date 10/07/2013
Contractor CUMINGS ELECTRIC INC Category 612-Residential-Single FamilyAddition/R Plan
Inspector Adam Krause :
Service New � Change 0 Temp � N/A � Type � Overhead � Underground
Volts Circuits Luminaires
Amps Switches Receptacies :
Appliances ��—
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Use/Nature of FR/REMODEL LOWER LEVEL *`debit acct
Work ',
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Fees: Valuation $500.00 Plan Approval $0.00 Permit Fee Paid $30.00
Issued By: �J ! 0 Iw Date 10/07/2013
❑ Permit Voided � Parcel Id# 1224310000
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 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.
�t 07 2013 8: 47RM HP LASERJET FRX p� i s
� Diviqioa o! Ia�p�etion earviaee
� 215 Church Avenue }
P.O. 8ox 1130
� Oehko6b� WI 54903-1130
F�% (910) 136-5084
Fhone (9�0) 236-5046
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EL�CTRICAL PERMIT APPLICATION
A11 information after bold catcgories must be provided.
=ncornplete application� will not be procee►aed.
DATE /07/13
JOB ADDRESS 1605 Rivermill soH No. C453-00 ;
owrrER SM Salzieder
CoNT�CTOR CUMINGS ELECTRIC INC.
CH�CK ALL AFPLICABT.g
V9E CAT�OORY� SINGLE FAMILY� DUPLEX❑ MULTI-FAMILY� RENTAL� F
CaMMERCIALO INDUSTRIAL❑
sExv=cEc N�w ❑ CHANGE ❑ TEMPORARY ❑ �voT APPLICABLE � £
rYPS: OVERF�AD ❑ LTNDERGROUND � NOT APPLZCABLE �
�
NUMBEA OF F2XTURES x 6wzTCxES x REC�pTACLES X CiRCt7zTs
!►MP8 _ VOLTA � p�gg
CI�ECK ALL ADPLICASLE
R�xGE 0 WATER HEpiTER ❑ a�aAaE DIBPOSAL � DRYER ❑
DI6HWA6HER ❑ FAN OR BLOWER ❑ FURNACE � A/C �
ELFCTRIC 9IC3N ❑ MOTORS � GAS PUMPS [� OTHFR
D$SCRIyTION OF ALL P10RK BEINC3 DONE Remodel
VALDE (Iacluding lnbor and all mat�ri�l• iacludiaQ liQhe �iktur�s) ,��Q,�O
aax�aT rea,
1�AATER ELECTRIC=AN RICIIaCd WAf12AI
Submit payment with application. Failure to pay within 30 dayB will result in
fees being doubled or $10a . 00 plu9 the r�.ormal permit fee, which ever ip greater.
OR
Check here if yo►� wane th�e procesaeB thro� h your accocu�t �
#100-0750-2515-00000 '
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