HomeMy WebLinkAbout0046087-Electric (service change) �3
CITY OF OSHKOSH N°- 460 7
� � PERMIT - APP I N A RE RD .
L CATI O N D CO
�
� TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
- - - - - - - - - - - - - - - - - - - - -� - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ADDRESS / Z� �S r�AS�'�-
PLAN NO.
OWNER v�� /;
DESIGNER
USE/NATURE OF WORK
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
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 S� Final/O.P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNAT � —�g'� �
AGENT/O NER DATE
ADDRESS
TELEPHONE i
f
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AFFIDAVIT RELATING TO SECTION 13.12(C) OF A GENERAL ORDINANCE OF THE
CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS AND
PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNT�
��'r f��',l�ir�--- / Za t,f/. �S�C�
,
(Name) (Address)
first being duly swom on oath, deposes and says that he is not a licensed electrician in the City of
Oshkosh and that he has applied for an electrical permit to do electrical work in a residence
and/or auxiliary buildings (intended solely for purposes associated with a residence)which is
owned and occupied by him, or is being constructed in his name, as his personal home and that
said residence or auxiliary buildings being so wired aze not to be used or erected for rental
purposes or for resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by the permit applied for in
connection with this affidavit, must be done only by this affiant and that he cannot employ others
to assist with the electrical work but members of his immediate family.
/
Dated this��day of - , 19�:�
c�
Subscribed and sworn to before
this day of . 19_.
Notary Public, Winnebago County, Wisconsin
My Commission Expires: