HomeMy WebLinkAbout0030322-Electric /� CITY OF OSHKOSH N°_ 30322
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC � PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - k
ADDRESS— ��-' � ` �'�� ��' PLAN NO. '
OWNER ��/�//C.0 P� � ��z/6..�� `
DESIGNER
USE/NATURE OF WORK /l �-,, ,��-z����j -�-�-� �
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 �
Electric Serv. N ❑ Change ❑ Temp Type Volts Amps
� Fixtures r�Switches v Receptacles '�Circuits �
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: Valuation $ ����-�-Permit Fee Paid $ �-�, Park Dedication $
ISSUED BY Date ��_,�� Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE- ` v� � � \ � ��`ZO�q'�
AGENT/OWNER pA�
ADDRESS � ��2 �r-� ��� ►y2�. _u��lO�'
TELEPHONE S
r AFFIDAVIT &ELATING TO SECTION 13.12 (C ) OF A GENEAAL OBDINANCE
OF THE CITY OF OS�SOSH AELATING TO T� LICENSING OF ELECTAICIANS
�' AND PHOVZDING PENALTIES
,
3TATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
�C N PEC, �1 . ��-1�R Dla� � �� l.,J , � -�,,•
Name Address
first being duly s�orn on oath, deposes azid says that he is not
a 2lcensed electrician in the City oP Oshkosh and that he has
appl�ied for an electrical permit to do electrical work in 'a
residenae and/or ausillary buildings (intended solely for pur-
poses assoclated o�ith a residence) �hich is owned and occupied
by him, or is being constructed in his name, as his perscnal
home and that said residence or auziliary buildings being so
. v►ired are not to be used or erected for rental purposes or f'or
� resale to present or prospecti4e purchasers. '
APfiant understands that the electrical wori� authorized by
the permit applied for 3n connection with th3s afPidavit , must
be done only by th2s afPiarlt and that he cannot employ others to
assist �rith the electrical� work but members of his immediate '
fa�ily.
a
Dated thi s O day of �v� . , 19 `�2..
'/�• �
_. .-- --._ _ �
�---
Subscribed and sworn to before
this _ day oP , 19_.
,+ ' ,G-t�
� Notary Pub11c, Wlnnebago County, Wisconsin � �
� ��� � �
My Commission Ezpires:
. --__�� _1
PERMIT NO. .���_� . APPL. DATE
ELEC. CONTR. -
. // � //
OWNER �G .�� �C-�-�L�`r��
. � � - �L� r �
P,DDRE
NATUR OF WORK
. �� L
�T�'^ SERV NEW CHANGE TEI"1�• -
E VOLTS �S
FIX' S � SW'S �-- RECEPT' S ,� CIRC'S
AvALIANCES _
GN
N P. ROU N ' � ERVICE FINAL
E . COST Cf C�-� PERM T FE � � DAT PD. �
REMP,RKS - -
�
, �