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AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH ?ELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGO COUNTY )
Name -~'' Address
first being duly sworn on oath, deposes and says that he is not
a Licensed 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 is owned and occupied
by him, or is being constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired 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 in connection with this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this ~_^ day of ~ C ~ c , 19
~ ) ~
Subscribed and sworn to before w
this 1~ day of
191.
Notary Public, Winnebago County, Wisconsin
M Commi s s 1 on Expires ; NY COMMISSfON EXPIRE
y JULY 20, 19$1
Permit No.
Contractor
Owner
Address
New Service "
Change Service
Temp .....Service
Range
Water. Heater
GarUage Disposal- ~~
Dishwasher
note' ~~ ii- '7 7
Furnace
Electric Sign
Air Conditioner
Gas Pumps
Fixtures ~
Switches „~
&eceptacles ~
Dryer Circuits /-a D ,~~
Fan or Blower Service Cleared
Motors O.K, to Close
Date Issued v ~ _ 1,'E''j Final Inspection ~j- ~ ~2
Remarks: ~~~