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'0 m c CI) :::l CO () .::Jt. :r: ... e Z <9 0 >-- :a 00 0 :r: ctl .,..: I- .S Ol i5 i= :E E Ol ctl l- e) Ol e 0 C/) - :E ... ... ... e - 0 .~ ''::: .!!1 ''::: ~ 0 (f) (f) ~ ~ Ol E ~ ... 9 ~ Ol Ol (f) Ol E "0 - 0 :::l - :) ca ~ 00 - - 0 <( e - W U <Il 0.. 0 Ol :::l ::i ::i ca ctl ctl ctl :::l Ol <Il .- - Q) - ~ :r: a. ....I - ~ W :::l 0 >- ~ ctl ....I Ol x 0. C/) - >- ca D- CO CO :s: CO :s: :s: 2 :s: (f) a::: :I: u.. () (f) () () w i:U 0 u:: <( UJ 0 0 ..J I- Z PERMIT NO. 7t/7 DATE ~-;3 --85 ELEC. CONTR. OWNER ADDRESS NATURE OF WORK ELEC. SERV. Nlnf ~~~?s ....~ APPLIANCES I'GNS NSP. ROUGHIN EST. COST REMARKS ~c~~ CHANGE. . VOLTS .. $~ ~ Rll:CEP'l"S ~ ..~ ...-/~~~ .---- := TEMP . AMPS CIRC' S. ?>(=: = . . AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE OF THE CITY OF OSHKOSH RELATING TO THE LI9ENSING OF ELECTRICIANS -. AND PROVIDING PENALTIES , , ~ STATE OF WISCONSIN) ) 5S W INNEBAGO COUNTY ) TE~.L rorfi'il' Name) , / rO f /110 CtI;E>>y J7' (Addres s ) f1rst be1ng duly sworn on oath, deposes and says that he 1s not a l1censed electr1c1an 1n the Clty of Oshkosh and that he has app11ed for an electr1cal perm1t to do electr1cal work 1n a res1dence and/or auxi11ary bu1ldings (1ntended solely for pur- poses assoc1ated w1th a res1dence) wh1ch 1s owned andoccup1ed by h1m,or 1s be1ng constructed in h1s name, as his personal home and that sa1d res1dence or auxiliary'buildings being so w1red are not to be used or erected for rental purposes or for resale to present or prospect1-"e purchasers. Af:f"1ant understands that the electr1cal work authorized by the permit applied for 1n connect1on with th1s aff1dav1t, must be done only by this aff1ant and that he eannot employ others to assist with the electr1cal work but members of his immediate fam1ly. day of . o/d , 19FJ: ~~~- Subscr1bed and sworn to before' .. . th~~:;aOftp:r:::J · 19& ." . ' ", ! Notary Public, W1nnebago County, \v1scons1n My Comm1ss1011 Exp1res: Sf /~&/P/ . Dated this y t.