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HomeMy WebLinkAbout0101572 EOSHKOSH ON THE WATER Job Address Contractor Service Volts Amps 642 W 17TH AVE HOMEOWNER [~ New (~) Change (~) Tamp CITY OF OSHKOSH ELECTRIC PERMIT - APPLICATION AND RECORD Owner Category No 101572 DAVID W/LORI A BUSKIRK Create Date 05/19/2003 612 - Residential-Single Family Addition/Ret Plan Type I© Overhead (~) Underground I Circuits 0 Fixtures 0 Switches 0 Receptacles 0 Appliances Use/Nature of .5/19/03 wire garage addition Work Fees: Valuation Issued By: $750.00 Plan Approval $0.00 Permit Fee Paid $35.00 Date 5/19/03 Permit Voided The undersigned, in applying for an Electric Permit to perform electrical work within a single family home, owned and occupied as the principle residence by the undersigned, hereby acknowledges per City Municipal Code Section 11-22, that other individuals may not be employed to assist with the work described in this permit unless said individuals are licensed by the City of Oshkosh to perform said work. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. Signature Date Agent/Owner Address OSHKOSH WI 5490 - 6705 Telephone Number OSHKOSH ON THE WATER CITY OF OSHKOSH ELECTRIC PERMIT -APPLICATION AND RECORD Job Address 642 W 17TH AVE Contractor HOMEOWNER Service ~ New O Change O Temp Volts Amps 0 Owner Category Circuits Switches No101572 DAVID W/LORI A BUSKIRK Create Date 05/19/2003 612 - Residential-Single Family Addition/R Plan Type (~ Overhead (~ Underground 0 Fixtures 0 Receptacles Appliances Use/Nature of 5/19/03 wire garage addition Work Fees: Valuation Issued By: $750.00 Plan Approval $0.00 Permit Fee Paid $35.00 Date 5/19/03 [] P e r_rn!!~..°. !c~e_d~ The undersigned, in applying for an Electric Permit to perform electrical work within a single family home, owned and occupied as the principle residence by the undersigned, hereby acknowledges per City Municipal Code Section 11-22, that other individuals may not be employed to assist with the work described in this permit unless said individuals are licensed by the City of Oshkosh to perform said work. In the performance of this work I.agree to perform all work pursuant to rules governing the described construction. Signature ~ 7(~_ ~,~,~ _, .~~,J~. ~ Date Agent/Owner Address OSHKOSH WI 5490- 6705 Telephone Number