HomeMy WebLinkAbout0041450-Electric (garage) (o/v
CITY OF OSHKOSH N� 41450
� PERMIT - APP -
LICATION AND RECORD
,
TYPE: BLDG ❑ HTG ❑ ELEC � PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS O O 3 ^ PLAN NO.
OWNER �G�� N ��
DESIGNER
USE/NATURE OF WORK
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 0��'u''� ��'�'� �'���-
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures � Switches � Receptacles ���Circuits v
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 $ �S~'d v Park Dedication $
ISSUED BY ` Date � � �_ Final/O.P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE r
AGENT/OWNER DATE
ADDRESS
TELEPHONE�
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AFFIDAVIT BELATING TO SECTION 13.12 (c ) OP A GENEAAL 08DINANCE
OF THE CITY OF OS�SOSH AELATING TO THE LICENSING OF ELECTI3ICIANS
AND PHOVIDING PENALTIES
3TATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
, :
, � � , /o 0 3 �/�
Name Addres
flrst being duly sworn on oath, deposes and says that he is not
a liaenaed electrician in the City of Oshkosh and that he has
appl�ied for an electrical permit to do electrical work in a
residenae and/or auziliary buildings (intended solely for pur-
poses associated orith a residence) which is owned and occupied
by him, or is being constrvcted in his name , as his perscnal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
� resale to present or proapective purchasers.
At'Fiant understands th�t the electrical worls authorized b�r
� the permit applied for in counection with thls af'2'idavit, must
. be done only b9 thts affiant and that he cannot employ others to
. assist arith the electrical work but members of his immediate
Panilp.
Dated this day of � , 19�
�
��
Subscr�bed and sworn to before
this _ day of , 19_•
Notary Public, Winnebago County, Wisconsin
My Ccmmission �acpires:
''' . APPL DATE %��� �
PERMIT NO. ���5 �
ELEC. CONTR. �
OWNER �� r �°t'�°�
. �
A�DRESS a d
NATURE OF WaRK
-� CHANGE TE�.
` EC. SERV. NEW VOLTS p'�S
DE C. '1'YPE RECEPT' S CIRC' S
FIX' S SW
�
APPLIANCES
SI�GNS SERVICE FINAL � �Z 9`l
INSP. ROUGH N pE�IT FEE ��or DATE PD:i
EST. COST
RE�KS .
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