HomeMy WebLinkAbout0035956-Electric (furnace & a/c) ���
CITY OF OSHKOSH N°- 35956
� PERMIT - APPLI
, CATION AND RECORD
� TYPE: BLDG ❑ HTG ❑ ELEC� PLBG "
❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � � � � 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
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ELECTRIC CONTRACTOR
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Electric Serv. New ❑ Change�Temp ❑ Type��� Volts�� Amps �� �//�
Fixtures� t�Sw'ches 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
/
FEES: Valuation $ ��O• d D Permit Fee Paid $ -� '�� Park Dedication $
ISSUED BY 1� �-!�-�-!�..-�- Date 9�y �3 Final/O.P.
In the performanc this work gree to perf all work pursuant to rules governing the described construction.
,
SIGNATURE 7'/y��
AGENT/OWNER DATE
ADDRESS ��6�' ���f�'�
TELEPHONE M
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AFFIDAVIT F�ELATING TO SECTION 13 .12 (c ) OF A GENEAAL ORDINANCE
" OF TI3E CITY OF OSBKOSH AELATING TO TI� LICENSING OF ELECTF3ICIANS
AND PAOVIDING PENALTIES
STATE OF WISCONSIN)
) SS .
WINNEBAGa COUNTY )
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Name Address
flrst being dul� sworn on oath, deposes and says that he is not
a 2lcensed electric�an in the City of Oshkosh and that he has
applied for an electrical perm3t to do electrical work in a
residence and/or auailiary buildings (intended solely for pur-
poses associated a�ith a residence) which is owned and occupied
by him, � or is being constructed in his name , as his personal
home and that said resideace or auxiliary buildings being so =
wfred are not to be used or erected for rental purposes or for
� resale to present or prospecti4e purchasers.
Af'fiant understands that the electrical work authorized by
the permit applied Por in connection w2th thls aPfidavit , must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members cf hls immediate
faaily. �
Dated this L day af , 19��
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Subscrlbed and sworn to before
,/ ��„„��.�....,,,, :
thi s � day of C/ c��-�c� 19 , ,�o,•••'' �A yy�'"��,,,, �
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PJotary Public, Winnebago County, tdisconsin= ��.A � :
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Mp Cammission �xpires:_ ��`/ y��l�.� y''�ql�'•���`.��•��c°�°,.-
ya,,�F�W ISC..N``a�
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� 3�/ � 3 ' 3 � �°�/ Z°` j�'
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., 11��t.'�c` L3G � �`9/7
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PERMIT NO.����5 (� • APPL. DATE � ��/y�
ELEC CONTR )�d2i/`�t,G�(
OWNER /�-�C.l��^l� ��.^�'li/f— --
.ADDRESS ��� C •
NATURE OF WORK �
�LEC SERV NEW A�`i � TEMP.
DESC TYPE cVaL'I`S SK/ AMPS Zc� a �.�Y
FIX' S SW' S RECEPT' S CIRC'S
APPLIANCES
� SI�GNS
INSP ROUGHIN SERVICE�i / � FINAL
EST COST PERMIT FEE DATE PD.
REMARKS
`� ��' <� 4 �--„�?�._�_ cc ,� .a%Gr:�: i
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