HomeMy WebLinkAbout0102115 EOSHKOSH
ON THE WATER
Job Address
Contractor
Service
Volts 120
1265 S WESTHAVEN DR
LARK ELECTRIC
[~ New (~ Change (~ Tamp
Amps 20
CITY OF OSHKOSH
ELECTRIC PERMIT - APPLICATION AND RECORD
Owner EDWARD/LOIS RIDDICK JR
Category 612 - Residential-Single Family Addition/Ret
Type I~ Overhead
Circuits 0
Switches 0
No 102115
Create Date 06/11/2003
Plan
~ Underground
Fixtures
Receptacles
Appliances
Use/Nature of SFR/Install outdoor outlets.
Work
Fees: Valuation
Issued By:
$500.00
Plan Approval
$0.00 Permit Fee Paid
$20.00
Date 06/11/2003
Permit Voided
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
Agent/Owner
Address 927 N LARK ST PO BOX 3206 OSHKOSH WI 54903 - 3206 Telephone Number
920-231-8625
City of Oshkosh
Division of Inspection Services
P.O. Box 1130
Oshkosh, WI 54903-1130
Phone (920) 236-5050
Fax (920) 236-5084
ELECTRICAL PERM IT APPLICATION
All information after bold categories must be provided.
Incomplete applications will not be processed.
O/HKO/H
ON THE WATER
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box I 128,
Oshkosh WI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
i£ you want this processed through your account []
JOB ADDRESS
DATE 7 ._J'~,xd~ ~::~.~
OWNER
CONTRACTOR .z~',~/~/-~
CWECK [] ALL APPLICABLE
USE CATEGORY
I~Single Family r'lDuplex r-lMulti-Family F'lRental
SERVICE nNew F1Temporary TYPE
F1Change F1Not Applicable
F1Commercial r-Ilndustrial
I-IOverhead F1Not Applicable
I-'lUnderground
FILL IN THE APPROPRIATE BLANK WITH THE NUMBER
VOlts zzo / Receptacles #
Phase /
Amps - 2. O Switches #
Circuits
Fixtures
CHECK [] ALL APPLICABLE
FIRange
F1Fan OR Blower
F1Motors
F1Dishwasher
UIFumace
F1Gas Pumps
FIGarbage Disposal
E]AJC
mOther
DESCRIPTION OF ALL WORK BEING DONE
F1Dryer F1Water Hearer
FIElectric Sign
VALUE (Including labor and all materials incluOi~g light fixtures) $
MASTER ELECTRICIAN' r~..(-~. ~ ,9..p ~, _ ~
3/02