HomeMy WebLinkAbout0009959-Electric (rewire house) .
/, ' " CITY OF OSHKOSH No 09959
`' PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC,�PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS_ � � � �! `� �l�/"� � PLAN NO.
� •
OWNER '
.
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
i
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ ype Volts Amps
Fixtures V� Switches - Receptacl s �-- 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
O
FEES: Valuation $ � �� `-- Permit Fee Paid $ /� Park Dedication $
ISSUED BY Date � /�f � Final/O.P.
In the performance of this work I agree to perform alt work pursuant to rules governing the described construction.
SIGNATURE iC��i��`� ��!� �� � s� `J �
AGENT/OWNER DATE '
ADDRESS ��' /3 �-��{� �-Z CO��t-� -Z.5�5��7 ?` �
TELEPHONE#
AFFIDAVIT $ELdTING TO SECTION 13.12 (c ) OF A GENEAAL OADINANCE
+� OF Tf� CITY OF OS�LOSH AELATING TO T� LICEDTSING OF ELECTBICZANS
, AND P80VIDING PENALTIES
►
3TATE OF WISCONSIN)
� ) SS
WINNEHAGO COUNTY )
�f--,�-rJ , o�/3 G�G�Z._a�-aC.=- �iZ. '
Na Address
first being duly sworr� on oath, deposes and saqs tl�at he is not
a liaensed electr4c�an in the City oP Oshkosh and that he has
appl�ied tor an electrical permit to do electrical work in a
residence aad/or au=Sliary buildings (intended solely for pur-
poses associated xith a residence) �hich is owned and occupied '
by hlm, or is being cvnstrvcted in his name, as his personal
home and that said residence cr au=Zliary buildings being so
vrired are not to be used or erected for rental purposes or for
� resale ta preseat or prospective purchasers.
AfPiant understands that the electrical woris authorized by
the permit applied tor in connection with this a.ffidavit, mvst
be done onlq by thts aPfiaut and that he cannot employ others to
assist �rith the electrical �rork but members of his immediate
Pamilp.
D�ated this / � day of � _ , 19_�
��� ���-��-�i�-
Sv�scrlbed and sworn to before
tY�is 1 g�_ day ot' , 19�.
Notary ?�blic, Wlnnebago County, ti+lisconsin
My Commiss�on Expires: 7 �
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