HomeMy WebLinkAbout0032471-Electric (service change) (� ��
� CITY OF OSHKOSH N°_ 32471
�' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC pq, PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � �` � � �� � / �`�C' `�� PLAN NO. � '
OWNER
G�ir/"����"t`( � "
DESIGNER
.
USE/NATURE OF WORK
3 -�d 3 �aa
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
r
ELECTRIC CONTRACTOR :
Electric Serv. New ❑ Change �j Temp ❑ Typ� Volts��_� Amps ���
Fixtures� Switches � Receptacles�— Circuits—�(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
— o
FEES: Valuation $ �� Permit Fee Paid $ �� �1 Park Dedication $
ISSUED BY Date l "l��'�3 Final/O.P. � a->�9�� .
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
�
�� 7 �, � A
SIGNATURE,
AGENT/OWNER D TE
ADDRESS��-!� �L, '`� �V� ���e�l�IL-C..OS/L �3,� � ��o� '
TELEPHONE#
Ar^FIDAViT P.EZ,�ITING TO SECTION 13 .12 (c ) CP A GE:VE.�..?.i CRDI�tANC�
OF T� CITY OF OSEKOSH F3ELATIYG TO THE LICE'NSI�JG OF EI.:C'I:�IC��NS
'� AND P:304IDI�JG PEN.�LTI�,S
�
� STATE OF WISCONSIY)
) SS
WINNEBAGO COUNTY )
Y ra�. 1 I ; s , U �v f� �1 cre.. �.
Name .�dd�e s s )
flrst being duly s�rom on cath, deposes and says �hat he is not
a 2lcensed electric�an in the Cit� oP Oshkash and that he has
applied Por an� electrical perm�t to do electrical work in a
residence and/or auaillary buildings (Sntended solely for pur-
poses associat�d �rith a residence) �rhich is owned and occupied
by hia, or is being constrvcted in his name , as his personal
home and that said r�sidenc� or auxili�ry buildings being so
` �rired ars not to be used or erected for rental pur�oses or for
:esale ta present or prospecti�e purchasers.
. Af£Sant understands that the electrical wor� authorized by
the per�it applied Por 3n connection with this af.*idavit , mvst
be done only by this afPlant and thaL he car.not employ othe�s to
assist xith the electrical work but memcers of his immediate
fanily.
I�Zted thi s g day of �JQ�'L , 19�•
`�-N- (-u L.�%�Q�r`e-
Suc�sc�;bed and sworr. to before
t�i s � day of , 19�.
�
iJotar� ?ubllc, '�JSnnebago County, Wisconsin
+ �I� Cammyssion �x�ires: a� 2 9