HomeMy WebLinkAbout0158518-Electric (pedestal change out) � CITY OF OSHKOSH No 158518
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1206 INDIGO DR Owner DONALD/VICKI LOFGREN Create Date 10/29/2013
Contractor KOLLMANN ELECTRIC LLC Category 610-Residential-New Single Family Servi Pian
Inspector Adam Krause
Service � New � Change � Temp � N/A ' Type � Overhead 0 Underground '
--
Volts 120/240 Circuits Luminaires
Amps 200 Switches Receptacles
Appiiances
,
Use/Nature of MO61LE HOME/ pedestal change out
Work
"ck#3125"
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Fees: Valuation $1,000.00 Plan Approval $0.00 Permit Fee Paid $70.00
Issued By: �. Date 10/29/2013
❑ Permit Voided' Parcei id# 1307310100
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 26 VAN DYNE WI 54979 -26 Telephone Number (920)273-0701
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,WI54903-1130
Phone(920)236-5050
Fax (920)236-5084 H
ON THF WATFI���
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 54903-1128. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the
normal permit fee,which ever is greater.
OR
If vou are a contractor participati� in the Permit Fee Account System and have adeguate funds, check here
if vou want this processed through your account ❑
DATE (D'��–'�3
JOB ADDRESS l��b ..�N�-�o .D.�. RECEIVED
OWNER t��� �i0ytr c..S '
CONTRACTOR /�„//�v.�-� ���-�`�-"c" l L � OCT 2 8 2013
DEP,�i2TR9EtiT OF
CHECK�ALL APPLICABLE COJ1�1Ui�Ty�EVELOPMENT
TNSPECTiO4 z�'Rt��C£S Dl�7SIQN
USE CATEGORY
�.Single Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE ❑Overhead ❑Not Applicable
�Change ❑Not Applicable �Jnderground
FILL IN THE APPROPRiATE BLANK WITH THE NUMBER
Volts �� /�2�G Receptacles# '� Circuits# �
Phase ( —
Amps �UU Switches# Fixtures#
CHECK 0 ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower ❑Furnace ❑A/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other
DESCRIPTION OF ALL WORK BEING DONE P2Gi��li'I �`i�,..y� G��
j 'y���ea
VALUE(Including labor and all materials including light fixtures)$ /��C�J
MASTER ELECTRICIAN
3/02