HomeMy WebLinkAbout0039574-Electric (garage) �/�'
/� CITY OF OSHKOSH N°- 39574
� `
PERMIT - APPLICATION AND RECORD
� �
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS J� 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 ❑ FueUSystem Heat Loss BTU'S
ELECTRIC CONTRACTOR �
Electric Serv. New ❑ Change ❑ Temp ❑ Type Vofts Amps
Fixtures Switches �eceptacles �� 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 $ � ���� � Permit Fee Paid $ �� � Park Dedication $
ISSUED BY ` Date Z Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUFj � ����s'�- S' 7 S�� %�S�
AGENT/OWNER DATE
ADDRESS
TELEPHONE#
,
� AF'FIDAVIT AEI�TING TO SECTION 13.12 (c ) OP A GENE.3AL OADINANC�
OF TI3E CITY OF OS�OSH AF7.dTING TO TI� LICENSING OF E�CI�ICI.�NS
AND PAOVIDING PENALTIES
ST�TE OF WISCONSIN)
) SS
WINNEHAGa COUNTY )
� � � r � 9 /S" /fi �ir,� r�
(Name Add��e s s
2'Srst being dulp sworn on oath, deposes and says that he is not
a �icensed eleatric�an in the City of Oshkosh and that he has
applled for an eleatrical permit to do electrical work in a
residence and/or aualllar� bulldings (Sntended solely for pur-
poses associated a�ith a residence ) �vhich is owne� and occupied
by him, � or. is being canstrvcted in his name , as his perscnal
home and that said =esidence or auailiary buildings betng so
wlred are not to be used or erected 2'or rental purposes or for
resale to present or prospecti4e purchssers.
Afflant � undezstands that the ele�trical wor�s authorized bp
the pe�it applled Por in connection •�ith this affidavit , must
be done only b� this af£Sant and that he cartnot employ others to
assist �rith the electrical woris but� members of his immediate
fanily.
Dated thls � `/ �Y a�• � � �,
- � 19_.
� '
Subscribed and sworn to be;ore
this dap o£ , 19_•
�Jotar;� ?ubllc , Winne�aga Ccunty, ldisconsin
M� Cammiss3on �x�ires: