HomeMy WebLinkAbout0159031-Electric (service change) � CITY OF OSHKOSH No 159031
OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3767 GLENAYRE LN Owner STEVEN SIMMONS 8 APRIL MATHE Create Date 12/10/2013
Contractor M.R.TEAS 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 :
Appliances ---
� �
Use/Nature of �MH\Replace UG service due to frost damage. Repaired temporariliy 12-9-13. —�
Work '
__. J
Fees: Valuation $850.00 Plan Approval $0.00 Permit Fee Paid $62.00
Issued By: � Date 12/11/2013
❑ Permit Voided', Parcel Id# 1278400000
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 uthor' to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit appli wi i an sement,the City strongly urges the permit applicant to contact the easement
holder(s)and to s r a s ap Is before starting such activity.
Signature � Date �a-���3
AgenUOwner
Address 7065 WOODENSHOE RD NEENAH WI 54956 -9747 Telephone Number (920)720-2288
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,WI 54903-1 Li0
Phone(920)236-5050
Far (920)236-5084 01HK01H
ON THF WATFR �
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 particiPatin� in the Permit Fee Account Svstem and have adequate fisnds, check here
if vou want this processed throu�h vour account ❑ :
DATE f� `f/ –/3
,roB annuESS 3 7�0 ^7 �/� ���r�
OWNER�1����P
CONTRACTOR ��j �, �� � �1/�
CHECK 0 ALL APPLICABLE
USE CATEGORY
�lSingle Family ❑Duplex ❑Multi-Family ❑Rental ❑Commercial ❑Industrial
SERVICE ❑New ❑Temporary TYPE ❑Overhead ❑Not Applicable '
�Change �Not Applicable ❑Underground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
Volts /2 v l�y0 Receptacles# Circuits#
Phase � �_
Amps �C� Switches# Fixtures#
CHECK�ALL APPLICABLE
❑Range ❑Dishwasher ❑Garbage Disposal ❑Dryer ❑Water Heater
❑Fan OR Blower ❑Furnace ❑A/C ❑Electric Sign
❑Motors ❑Gas Pumps ❑Other������ �-�i�yyt�
DESCRIPTION OF ALL WORK BEING DONEj S�P r `i i`c � ���Y �S�S� �
c��
VALUE(Including labor and all materials i luding light fixtures) $ �J� —
MASTER ELECTRICIAN
3/02