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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 )
J /A / .
J �, /•A • LLB/ :_! _! .ter /• i �.
(Name Ad
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 �6 day of .wry 1990
•
Subscribed and sworn to before
this 6' day of � - , 19 "o •
7 ,1■)Pci )/". Al‘..,e
Notary Public, Winnebago County, Wisconsin
My Commission Ex ires:My c h 7. 1 9 Expires
P March 7. 1982 2
•
PERMIT NO . 3 !o 1 7 / APPL . DATE 7 2 6/I c,)
ELEC. CO�NTR.
` V t. C
OWNER ��
,
ADDRESS / (o V 4_,-.:„......e.„4_0_47_, NATURE OF WORK « i ; i ,
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES 4-
S IGNS 4n,
INSP. ROUGHIN SERVICE FINAL / et
EST. COST ,-z9 PERMIT FEE / DATE PD —0
REMARKS / /"
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