HomeMy WebLinkAbout0014881-Electric (furnace)
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, . .
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO" COUNTY )
JYI1J1AfefJ :L. 0/{ ~-
( Name )
, / 9' ;;2 /~tI~~
(Address) .
first being duly sworn on oath, deposes and says that he is not
a lioensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or auxiliary buildings (intended solely for pur-
poses associated with a residence) which 1,s owned and occupied
by him, or is being constructed in his nam~, as hls personal
home and that sald residence or aux~liary buildings being so
wlred are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
. the permit applied for ln connection with th1saffldav1t" must
be done only by this affiant and ,that he cannot employ others to
assist with the electrical work but members of his 1mmediate
faml1y.
Dated th1s
o'th-
Q day of
a Uj/r.JJOt ,
, 19~.
x jtJ ~';:l- /1 ~
Subscribed and sworn to before
'this ~.'~_ day of O~~
~ D~~, n~~
I," ~
, 19~3.
-
r Notari Public, Winnebago County, Wisconsi.n
My Comnd.sslon Explres: 8- tiC f&c> .
",.
<II
EERMIT.l',"-L~ ~Q
ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERV. NEW TEMP.
DESC. TYPE AMPS
:::~~ANCES SW' S ORC' S_ ~
EiSSsITsG:. ~c~~GH~~A~L - SERVICE L ~L~_~~
~ .~~~ ~PERMIT FEE ~"-!!{;~!J~"1'~!3
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