HomeMy WebLinkAbout0017621-Electric (garage) gi
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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 )
y
l
(Neme
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.
Afflant 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 �tip � , 19 i
•
•
K" vim
Subscribed and sworn
to before
this J
Qo,LL Makc.e(
f-) d ay of ,�v C,nZ , 19.
Notary Public, Winnebago County, Wisconsin
My Commission Expires: it /Do
PERMIT NO. / / APPL. DATE 7 -/ 3 - Y
ELEC. CONTR.
OWNER )
ADDRESS F/!6
NATURE OF WORK
ELEC. SERV. NEW CHANGE
DESC. TYPE TEMP.
FIX'S VOLTS AMPS
D e S S �� RECEPT'S CiRC'
APPLIANCES
SIGNS
NSP. ROUGHIN SERVICE
EST. COST ! -/ FEE FINAL‘-
REMARKS DATE PD