HomeMy WebLinkAbout0046102-Electric � i {
� CITY OF OSHKOSH
N°_ 461 2
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � 2"Z , � PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK_L��(� �°�5��/y�
BUILDING CON7RACTOR
Size Sq. Ft. # Rooms # Stories Height
.
• Foundation Class of Const. Occupancy Permit
.
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New� Change ❑ Temp ❑ Type Volt�� Amp�
Fixtures Switches 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 O O. c�c7 Permit Fee Paid $ -��•�� / Park Dedication $
ISSUED BY �'�"'� Date S — Final/O.P. �� � ' �/,�
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER DATE
ADDRESS
TEIEPMONE I
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t
PERMIT NO. T� 1 �2/ . APPL. DATE
ELEC. CONTR.��-�L�-
OWN�R /��u.c.� $�-C�.r.t.
T-
ADDRESS ��'2'� ��'�'"� �� -
NATURE OF WORK
C. SERV. CHANGE TEMP.
D C. TYPE V VOLTS ANiPS Oa �
FIX' S SW'S RECEPT' S CIRC'S
APPLIANCES
SIGNS
INSP. ROUGH N SERVICE �v �l i ' FINAL
EST. COST �� � PERMIT FEE D DATE PD. �
REMARKS
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. � ��
PERMIT NO. �tP I d '� . APPL. DATE
ELEC. CONTR. .
OW1�ER
D S 2"�-2 � C�C�r�-�'
NA OF WORK
G
RV. CHANGE TEMP.
VOLTS `� L AN�S /�
FIX'S S 'S RECEPT'S CIRC'S
AN
NSP. ROU N ER CE / F NAL
�
E . COS o 0 o PE S DATE PD. �
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