HomeMy WebLinkAbout0018556-Electric (move garage & rewire) � _ CITY OF OSHKOSH N° 18556
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC� PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � PLAN NO. ` .
OWNER �.��vi.� � � \ �`_
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DESIGNER
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USE/NATURE OF WORK '�P �– ��Z�' �
BUILDING CONl'RACTOR
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 ❑ Tem Type-�1� Volts �oAmps��
Fixtures�— S itches� Receptacles� Circuits �/���/�
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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
Q - � C
FEES: Valuation $ � u'� Permit Fee Paid $ ������ Park Dedication $
ISSUED BY Date ,� �!–"`�/ Final/O.P. �O ' �I– /D
in the performance of this work I agree to perform all work pursuant to rules governing the described construction. ,
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SIGNATURE � ��� � � Q
AGENT/OWNER DATE
ADDRESS ��.� �L "'�� E�`'� '�� � t7 O�
TELEPHONE# ��
AFFIDAVIT AELATING TO SECTION 13.12 {c ) OF A GENEF�AL 08DINANCE
OF T� CITY OF OS�OSH BELATING TO Z'� LICENSING OF ELECTAICIANS
AND PAOVIDING PENALTIES
3TATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
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N8� Addre s
first being duly s�rorn on oath, deposes and says that he is nat
a liaensed electrician in the City oP Oshkosh and that he has
appl�led for an electr2cal permit to do electr�cal work in a
resideaae aad/or au=iliary buildings (intended solely for pur-
poses associated xith a residence) which 1s owned and occupied
by hiID, or is being constructed in his name, as his perscnal
home and that said residence or auailiary buildings being sa
wired are not to be used or erected 2'or rental purposes or f'or
resale to present or prospective purchasers.
A2'£lant understands that the electrical work authorized by
the permit applied for 3n connection w2th thls affidavit, must
be done only by this afflarit and that he cartnot employ others to
assist with the electrical work but members o2' his immediate
Paoily.
Dated this _� day of /`�u ,,� , 19�.
� _ � ��.�"�--�
Subscribed and swora to before Gy'/ � �
this __ day of 1 , ,�
� 9
�--�JG�G���-�c�
Notary Pub11c, WSnnebago County, lJisconsin /�/
G� �
My Commission E=pires: / �����
PERMIT NO. �/� �� . APP . DATE � .�I ' ��
E C. CONTR. � ` �
OWNER '
ADDRE S �- �
NA E OF WaRIC �
,-�-2,�c'" a-�L--'t�� �
' . SERV. NEW GE 'I'EMP.
D C TYPE -- �-�- -- al�-- VOLT5 /Z �d AMPS c9 �
FIX' S SW' S RECEP� S CIRC'S '
APPLIANCE
SIGN ' �
NSP. ROUGH N =C' ° � -z / -{7, SERVICE Q� - ' �/-�'G� F INAL ` " ' G?
E . COST G� ------�ERM T FEE !U ` DATE PD. -�1-90
' REMARKS
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