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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)
WINNEBAGO COUNTY ) SS
fi , 4„4//4-4-j HZ/ 4 /77 - 4 :: Na 9 -
(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 b y
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 •.A day of \TU A(
•
•
.l //—
Subscribed and sworn to before
this • day of I r
tO
1922a 144.. _
Notary Public, innebago Count W
County, isconsin
My Commission Expires: : I QLUMMISSION EXPIRE',
p JULY 2n 1987
PERMIT NO. ' 7I 6 APPL. DATE
ELEC. CONTR.
OWNER
ADDRESS ff�
MATURE OF WIRK r , Af
EL - EC. SER . NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S, CIRC'S
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE s�! _ Q • FINAL p - 7,
EST. OST < PERMIT F aw s' pt.
REMARKS JUN 2 51980