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AFFIDAVIT RELATING. TOSECTIOtl.lJ.12 (c) OF A GENERAl...ORD~N@CE
OF THE CITY OF 05EKOSH RELATING. TO THE LICENSING .OF EtEC'rnlCIANs...
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) S5
WINNEBAGOCOUNTY )
/iJ/*( ~~58/N''i.
, Name
,
. /cPS-J hIfItJS~t/ 3T
(Address)
fl~st being duly swo'rn ono~th, deposes and says that he 1s not
a lioensed electrician in tl';e City of Oshkosh and that he has
appl1ed for an electr1cal permit to do electrical work ,in a
res1denoe and/or auxiliary buildings (intended solely for pur-
poses a.ssociated with a res1dence) which is owned and occup1ed
by him, or 1s be1ng constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
w1red 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 permi t applied for in connection wi th this aff1davi t t must
be done only by this ,affiant 'and that he cannot employ others to
assist w1th the electrical work but members of h1s 1mmed1ate
family.
Dated this r day of \-M;'\/' , 19~.
Sub~crlbed and sworn to
this R'ti
tt~/ ffry
before
, 19~.
Notary Publ1 c ,W1nne bag~.tife~~~p)t!,.\oJ1 sconsin
My C omm 1 s s1 on Exp 1 re s :' 'i;';'::'~~'l\;~<!:.;!,ii\~.~>\"'~'
"~RMIT NO:cr':Z3Y .~~PL ~~;~ J - Z' -p
;LEC. CONTR. &Ut77//l ~
~WNER ~~ ~~
\ ~
ADDRESS
NATURE OF WORK
TEMP.
AMPS ~
CIRC' S2.'5
=
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FIN A -"1-82-
DATE PD .I-15-g'l..
=
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I CHANGE
VOLTS
REC~PT I S I I-J
NEW
SW'S
:2...
SERVICE
PERMIT FEJff(7~&
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