HomeMy WebLinkAbout0010199-Electric (rewhire house) /� CITY OF OSHKOSH No 10199 :
`' PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC� PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ` ��� ( '��i� PLAN NO. '�
OWNER ���� �����
DESIGNER
USE/NATURE OF WORK ���'v`�`��
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
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ELECTF3IC CONTRACTOR
Electric Serv. New ❑ Change ❑ T mp ❑ Type Volts Amps
Fixtures ✓ —�witches �- Receptacles �ircuits�
P
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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 ,/ % CJ Final/O.P. �� �7 "o 0
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In the performanCe of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE � �-'�i"�-� R—�—`��
AGENT/OWNER DATE
ADDRESS ��� w 7� �� 72Z—�yS
TELEPHONE#
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, AFFIDAViT BEL�ATIMG TO SECTION 13.12 (c ) OF A GENEAAL ORDINANCE
OF T� CITY OF OS�SOSH SELATING TO TI� LICEDISING OF ELECTBICIANS
AND P809IDZNG PENALTIES
3TATE OF WISCONSIN)
) SS
WINNESAGO COUNTY )
�ci-�--��L� O' 1� ��,� I � I O 3� w �7-� �e
Name Address
first being duly s�rorn on oath, deposes and says that he is not
a 2laeased electrician in the City of Oshkosh and tha.t he has
appl•ied for ari electrical persait to do electrica.l work in a
residenae and/or ausiliary buildings (intend.ed solely for pur—
poses associated xith a residence) ahich is owned and occupied
by him, or is being canstructed in his name, as his persanal
home and that said residence or aux311ary buildings being so
�vired are aot to be used or erected for rental purposes or Por
� resala to present or prospective purchasers.
Af'£lant understands that the electrical work authorized by
the permit applied tor in connection with this affldaoit, mvst
be done only b9 this aPPiarit and that he cannot employ others to
assist �rith the electrical �ork but members of h3s tmmediate
fataily.
Dated this � day of s�����m�« , 19�•
��� ��
Subscribed and sworn to bePore
thi s �_„_ day of , 19�� .
Notary rublic, Wtnnebago County, Wisconsin
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Mp C�mmission Fxpires: 99
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� PERMIT NO. CJ � C . APPL. DATE - � - �
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� ELEC. CONTR. ' •
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' OWNER 'C
ADDRESS � � 3 � � �� l �
� NATURE OF WORK
� ELEC. SERV. NEW CHANGE TEMP.
� DESC. T PE VOLTS AMPS
� FIX' S S �t� ,��RECEPT'S CIRC'
� APPLIANCES
� SIGNS '
� INSP. ROUGHI - ��7 -�1� SERVICE FINAL `
� EST. COST �4--- PERMIT FE DATE PD ' 8
� REMARKS
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