HomeMy WebLinkAbout0023863-Electric (service change) r � CITY OF OSHKOSF� N° 23863
� `' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC �PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS �U � • �,��,1� PLAN NO.
OWNER �'� I�(C���W��
DESIGNER
USE/NATURE OF WORK � �' °`� 1� ' �
��G�-�(�'��$�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 ' r - � < <-
Electric Serv. New ❑ Change � Temp ❑ Type�� Volt�i�� Amps�1� � /���C.
Fixtures Switches Receptacles Circuits ��Y L---��
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
,
`'�� � Park Dedication $
FEES: Valuation $ � Permit Fee Paid $ ��
�ISSUED BY Date � �l �� Final/O.P. fP �l ��
In the performance t ork I agree to perfor ork pursuant to rules governing the described construction.
SIGNATU V
AGENT WNER D T .
ADDRESS
TELEPHONE# �
�
PERMIT NO. � � PL. D TE � r �� // �
ELEC. CONTR.
OWNER � � �
ADDRESS �� � � � � �Z�
NATURE OF WORK
z
EC. SERV. NEW CHANGE 'I'EMP-
D C. TYPE =� VOLTS c� �-`� AMPS 2 U o'
FIX' S SW' S RECEPT' S � CIRC' S �G
APPLIANCES _ V
.
SI'GNS
INSP. ROUGH N SERVICE � ����P FINAL -� -`��
EST. COST O� PERMIT FEE 13� DATE PD. -� ��/ :
REMARKS _
. �
I