HomeMy WebLinkAbout0003416-Electric (service change) /� CITY OF OSHKOSH No 03416
`' PERMIT — APPLICATION AND RECORD -
TYPE: BLDG ❑ HTG ❑ ELEC�PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT- -
ADDRESS � PLAN NO.
OWNER �
DESIGNER
USE/NATURE OF WORK�C �`�_�i�� �C/� r� J�Y�C�Z�
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR •
t Electric Serv. New ❑ Change (�J Temp ❑ Type Volts%� Amps�
Fixtures�— Switches � Receptacles�— Circuits� `
J �/��
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
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FEES: Valuation $ d Permit Fee Paid $ ��� � Park Dedication $
ISSUED BY Date ��j ` �� Final/O.P.�1�-�g7
In the performance of this rk I agree to perform work pursuant to rules governing the described construction. .
SIGNATURE
/ �,
ENT WNER DA E
ADDRESS
TELEPHONE#
' PERMIT NO. � � 'I �� APPL. DATE � -��`- �� �
ELEC. CONTR. �-�
,
OWNER
ADDRESS ' / � D l � l� ��-�
NATURE OF WORK �
ELEC. SERV. NEW CHANGE
DES�. TYPE �- D 3 `-.Zdd VOLTS z .yp AMpS2�
FIX' S s v✓ � RECEP � CIRC' S �
APF"�IANCES
SIGNS
INSP. ROUGHINp � � / - . SERVICE - Q� �' FINAL -% -S�
EXT COST /'SQD�--- PERMIT FEE p� DATE PD��Y
REMARKS �
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