HomeMy WebLinkAbout0011121-Electric (move meter outside) � � �
� _ CITY OF OSHKOSH No 11121
PERMIT APPLICATION AND 'RECORD
TYPE: BLDG ❑ HTG ❑ ELEC�PLBG ❑ SIGN ❑ ZONING �� FLOOD PLAIN�HEIGHT�
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ADDRESS ��� �1��� �U`� PLAN NO.
OWNER v ' �� ��-
DESIGNER
USE/NATURE OF WORK �--,\� �°- � * �° C�r`1
E� h° D� r`
BUILDING CONl"RACTOR �
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 �W� �'�
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps�
Fixtures Switches Receptacles Circuits
/�o.� � �e�e t--
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: Valuatio P r ee Paid $ � Park Dedication $
ISSUED BY Date �fl —3 `` Final/O.P. ��""1 d� ��
In the performance of this work I agr e perform all work pursuant to rules governing the described construction.
SIGNATURE
' -'( .L-L�_� _�-1��:�Z.� f L� ��-�);S
AGEN / WNER DATE -
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ADDRESS �_..2__�-{� `Li l� �(-L<'�, �-3����-��-7/i-�
TELEPHONE#
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AFFIDAVIT BEI.ATING TO SECTZON 13.12 (c ) OP A GENEAAL OADINANCE
OF THE CI7'Y OF OSF�OSH AELATING TO TF� LICENSING OF ELECTAICIANS
AND PHOVIDING PENALTIES '
3TATE OF WISCONSIN)
- ) SS
WINNEBAGO COUNTY )
�v C--��--c�. � l',c�, �� �v
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Name Address
first being duly satorn on oath, deposes and saqs that he is not
a 2laensed electrician in the City oP Oshkosh and that he has
appl�ied for an electrical permit to do electrical work in a
residence and/or ausil2ary buildings (intended soiely for pur-
poses associatsd �rith a residence) xhich is owned and ocaupied
by him, or is being constrncted in his name, as his personal
home aud that said residence or ausiliary bvildings being so
w2red are not to be used or ereated for rental purposes or for
� r�sale to present or proapective purchasers.
Af'fiant understands that the electrlcal work authorized by
the permit applied for in connectioa w2th this affidavit, mvst
be done only by thts at'Piant and that he cannot employ others to
assist �rith the electrical work but members of h3s immediate
famil�r.
Dated thls � � day of �C�� �� !�`— , 19�
� �-� �`,���_Gf�:
Subscrlbed and sworn to be2'ore
th�.s �_ da of , 19_.
Nota public, WSnneb County, Wisconsin
My Ccmmission Expires: 7 9 9Z