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Home My WebLink About0007375-Electric (service change) � CITY OF OSHKOSH N° 07375 `' PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC�PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ADDRESS � PLAN NO. OWNER ' J '�' � DESIGNER USE/NATURE OF WORK a? — �� 3 —�D . BUILDING CONTRACTOR Size Sq. Ft. # Rooms # Stories Height Foundation Class of Const. Occupancy Permit HEATING CONTRACTOR Hea� ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S r ELECTRIC CONTRACTOR Electric Serv. New ❑ Chang Temp ❑ Typ/�� VoltS `� Amps�� Fixtures Switches Receptacles Circuits e 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 $ / `� Permit Fee Paid $ ` � Park Dedication $ ` ISSUED BY Date � �-��~"�o p Final/O.P. ?J"��" g8 � In the performance of this work I agree to perform all work pursuant to rules governing the described const�uction. SIGNATUR�/o�i�� `7��`r� �-� AGENT/OWNER DATE . ADDRESS l/ � l/.u.. -y��.�,L � ��s�r/� �� .�.P�� /e 7-3 � TELEPHONE# > AF'FIDAVIT &EL,ATING T� SE�IZGId l 3.12 (a ) C� A GENEAAL OF?�I�tANCE OF T�E CI��I OF CifiKg�� T ,d��L4� � T� I�ZCENSING �� EZ�C�aICIARTS ,� AND P�O�TIDING Pv�t�`�S.�I�S : ' STATE OF WISCONSIN) ' ) SS WINNEBAC,� C�UNTY ) � 9 � `i fi!` ` Name � / Add ss ' flrst bei� dulp swor:� on oath, �.�po�es and says that h� �� rot a �Scensed e:iect:�,c:i�.n lr� t�� Ci�y o�' OsY�kosl� and that h� �:�: appl�lec� f�� a el��r�c�:� ��r��t ta cio electrical work ir. �. reside�ce �r.�/o$ �uail�,s�g b�il3ing� (int�r:ded salely f�� r- poses asscci�.t�d �ith � xc�id�r�c�) which is owned and oc�:�z;s�,ed by him, or is b�lr:� canstx°cact�d ir hi s name, as hls per�r;r��.�, � home arid t��t sal� �gir��rc� or �.uzili�.ry buildin�s bein� s�� wired are not ta b� v��:d c�.° �r�:ct�d P�r rental pur�ases o�° �'er � resale to pa�es�r�� x� �:;os�a��i e� �:��Y�,�s�rs. A2'fiant t�nd��t�,�3s tr�� k:e e,ectsicaZ work �uthor4 b��•:', by the pe�it a�p11�� f'o� in cc��:��ct�o� w2�h this affi�avit, �s.��t be done ��1� �� t�� af`fi�� fi�ad tn�� he cannot ea�ploy ot4ezMw°s to as�ist �.�r f�� 1��t;�ic�.l c°�M�e. �;;t nz�mbe�s of his i�ned�.i:,��,: fa�ily. 1-s.r� �.... .�'tal�� n-t..rd��-�.....� �'�� .�� t'.4� .. _.. ..,., ��/ . .d:�-...,as�9.1 ��"�• � .. . ..:.:.,��LLfB� -:..... -.,:. . .SUC�Cgi%c�'.: F1.s.:+`: S"Y*C:.< �O �+��,.."'.'::`.. .. , ��:is _.�5�� _ c%-�y� c�h .� .r.`>��1,.R_.__..rg � c�.�'�,• ��..�,..��,.��.�..._�..y ��.. �.E �� Notar� �'u�?.14� W�� :�r,,r.,� �v�.��,:,�r, t�� _,e_�i�l� , - � Mp Comm�ssio� �x�i�e�:� �' 9D �92� PERMZT NO ��/ APPL. DATE � -( � -�� ELEC. CONTR. � � OWNER �� C� � � ADDRESS �'- NATURE OF WORK ELEC. SERV. NEW CHANGE TEMP. DESC. TYPE - VOLTS � 2 f-f-O AMPS O FIX'S SW'S RECEPT CIRC'S APPLIANCES SIGNS � INSP. ROUGHIN SERVIC - �g$ FINAL - 6�g EST_ COST �� PERMIT FEE DA?E PD. �,3 REMARKS � � €