HomeMy WebLinkAbout0029598-Electric CITY OF OSHKOSH N°- 29598
� PERMIT - APP ICATION AND RE RD
l� C O
v
TYPE: BLDG ❑ HTG ❑ ELEC� PLBG`❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ';
ADDRESS � 'JIL�v (/U . �� � PLAN NO.
OWNER � .O �
DESIGNER
USE/NATURE OF WORK 7��
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation C�ass of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR (JL��f
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
G� z.�-� ��- ��Gz�
PLUMBING CONTRACTOR
BT WH _Disp WSoft CBasin
—Lav Sh DW —DF —San. Sewer
WC —FDr SP Ur Storm Sewer
—Sink LTub Eject —SS —Water
Other
FEES: Valuatio $ SOo�p � Permit Fee Paid $ ��'� � Park Dedication $
ISSUED BY ��-t�-�-- Date?��/'1�L Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
�_ 7� � - 9
SIGNATURE ,
AGENT/OWNER DATE .
ADDRESS �� � w � � � �3 � ��
TELEPHONE# .
�.
•
. r
AFFIDAVIT FiELATING TO SECTION 13.12 (c ) OF A GENEAAL ORDINANCE
OF THE CITY OF OS�LOS$ AELATING TO THE LICENSING OF ELECTAICIANS
AND PHOVIDING PENALTIES :
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
r-� � � S �� 3�G 4, � � (,�
� ���� ���
�
Name Address
2'irst being duly sworn on oath, deposes ar�d says that he is not
a liaensed electrician in the City of Oshkosh and that he has
appl�ied Por an electrical permit to do electrical work in a
residence and/or auziliary buildings (intended solely for pur-
poses associated arith a residence) which is owned and occupied
by him, or is being constructed in his name , as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or fcr
� resale to present or prospecti4e purchasers.
Af£Sant understands that the electrical work authorized bp
the permit applied for in connection •�2th thls at'fidavit , must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
faoily. .
�� �^ Q
Dated this � day of v� , 19/
-� �'
. �J .
Subscrib�d and sworn to before
� �
this � -cia� of , 19 .�, .
� y �
/ - � �`�°
%
PJotar Public, Winnebago County, lJisconsin
My CaIDmission Expires: � ( 9