HomeMy WebLinkAbout0006022-Electric (garage) n _ CbTY OF OSHKOSH N°_ 06022
PERMIT APPLICATION AND RECORD
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TYPE: BLDG ❑ HTG ❑ ELEC� PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ��� � � �` ✓ ` PLAN NO.
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OWNER •G��(�L
DESIGNER
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USE/NATURE OF WORK '
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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. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures� Switches �Receptacles `�� Circuits�
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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
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FEES: Valuation $ Permit Fee Paid $ ��-�� Park Dedication $
ISSUED BY Date ��—°�6 `� / Final/O.P.
In the performance s ork I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE �7 Z G �
AGENT/OW,�IER DATE .
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ADDRESS 2—�� `'� � � , ` p p � '
TELEPHONE# ��
f !�hereas the Gity Electrical Ordinance prohibits
` the installation of armored or unarmored cable in base-
r
ments and or garages, except rvhere the ceiling or wall
surfaces are permanently covered vrith plaster or other
permanent surfacing material, (I-we) the (owner-oavners)
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of the property at ZS�� �✓ �-5 , Oshkosh,
6�Jisconsin herewith agree to keep the ceiling of the base�
ment and or the ceiling and walls of the garage perman-
ently covered or change the �-viring to meet with the appro-
val of the Electrical Inspector. (I-we) further agree
that the permanent ceiling and wall covering will be
installed prior to occupancy of this property. In the
case of said building being already occupied (I-we)
l�-ea�, �
agree to comply within�.ei�jj� of signing of this paper.
Signed .
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l�itness ___
Date ._ D ZG �
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AFFIDAVIT I3ELATING TO SECTION 13•12 (c ) OP A GENEAAL OADINANCE :
OF THE CITY OF OS�OSH AELATING TO T� LICENSING OF ELECTf�ICIANS
AND P804IDING PENALTIES
3TATE OF WISCONSIN) � '
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„ WINNEHAGO COUNTY ) .
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l� (�-� , Z 3 � ( S --�
Name Address
first being duly s�rorn on oath, deposes and saqs that he is not
a 2laenaed electrlcian in the City oP Oshkosh and that he has
appl�ied for an electrical permit to do electrical wvrk in a
residenae aad/or auailiary buildings (intend.ed salely for pur-
poses asscciated o�ith a resldence) o+hich is owned arsd occupied
by him, or is being ccnstructed in his na.me, as his perscnal
home and that said residence or au�ciliarq buildings being so
�rired are not to be used cr erected for rental purposes or for
� resale to present or prospective purchasers.
At'Piant understands that the electrical work authorized by
the permit applied for in connection with thls affidavit, mvst
be done only by thts at'fiant and that he cannot employ others to
assist �rith the electrical work but members of his immed2ate
faoily.
Dated this da.y of (��'� ��3��- , 19,�•
Subsa:i�ed and sworn to before
�his � �,a�y of ���D� , 19�.
____�����,�. � ��, ���
Notary Publlc, Winnebago County, WSsconsin
Mp Ccmm2ssion Expires: ��/S����o