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AFFIDAVIT RELATING TO SECTION 13.12 (0) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
WINNEBAGO COUNTY ) SS
- 7 / 97 /4.2_. ( 2,4", (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 An 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 c>e 5 day of
•
‘!/-22„,e6e,:_
Subscribed and sworn to befo
this _ day of IV,
1
) _ /- /
•
Notary Public, W nn -ba o
�
g unt , Wisconsin
My Commission EX C , 1 981 EXPIRE
ire
P s : JULY 2 200, 1S
t�
PERMIT NO.
APPL. DATE �
ELEC. CONTR. / u-�
OWNER ! ? _
ADDRESS
NATURE OF /elf?)
jc'�, Qa�
- ,.
EL C. SE} V. EW CHANGES
DESC. TYPE VOLTS 7;26 a 4f AMP SC
FIX'S RECEPT S CIRC S
APPLIANCES ' ' ! - - .,/
SIGNS am/f-"
INSP. ROUGHIN SERVIC j - ,A10 A � ' , 4 FINAL //,‘‘)
EXT. COST PERMIT . " -` 7 DATE PD.
REMARKS
V C (.J v-
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